Cholesterol and Heart Disease – A Quick Look Beyond

The word cholesterol is inherent to heart disease. Just like Paris is the capital of France and the Moon orbits the Earth, so cholesterol is associated with heart disease.

And common knowledge extends further. Most people know that cholesterol is measured in blood and that there’s is supposed to be both good and bad cholesterol. Bad cholesterol may clog arteries, so by all means make sure it’s low.

Cholesterol and Heart Disease - A Quick Look Beyond

Of course, most of us know there is only one type of cholesterol. The “good” and “bad” has to do with the lipoproteins that carry cholesterol molecules in our bloodstream.

A standard lipid panel provides numbers for total cholesterol, triglycerides, low-density lipoprotein cholesterol (LDL-C) (1) and high-density lipoprotein cholesterol (HDL-C)(2).

LDL-C is often termed “the bad cholesterol” because high levels are associated with increased risk of heart disease.

On the other hand, HDL-C is usually nicknamed “the good cholesterol” because high blood levels are associated with less risk of heart disease and low levels are associated with increased risk.

Recently many experts and non-experts have cast doubt on the role of cholesterol as a causative factor for cardiovascular disease (CVD). The internet is flooded with articles and books have been published with titles such as the “Cholesterol Conspiracy” and “The Great Cholesterol Myth”. Some have suggested that the fat hypothesis is the biggest lie in medicine.

The opposite view is usually found among medical professionals. Cholesterol is regarded as a key player when it comes to cardiovascular disease;dietary recommendations aim at lowering LDL-C and cholesterol lowering drugs are often prescribed.

In a paper (3) published 2010 in the American Journal of Cardiology, William C. Roberts, editor-in-chief of the American Journal of Cardiology for the last 33 years wrote: “The lower the LDL cholesterol, the better, and this principle has been established repeatedly despite voices of the anticholesterol, antistatin fallacy mongers! It’s the cholesterol, stupid!

I believe healthy scepticism is the lifeblood of modern science. It is not about choosing teams and ignoring evidence that contradict our believes. Dogmatic assertions may get in the way of scientific progress.

So, let’s have a quick look at recent scientific results that may strengthen our understanding of the role of lipid measurements in assessing the risk of cardiovascular disease.

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Lipid Combinations

It is well known that high levels of LDL-C, low levels of HDL-C and high levels of triglycerides (TG) are each by itself a major risk factor for developing CVD (4,5,6).

But what about lipid combinations. What if both LDL-C and HDL-C are high? Will high HDL-C wipe out the risk associated with high LDL-C? And what about TG? How do they affect the mixture?

Interestingly these questions have not been addressed until lately. A paper published in the American Heart Journal in December 2014 (7) reports results from the Framingham Heart Study Offspring Cohort where the association between different lipid combinations and the long-term risk of cardiovascular disease was studied.

The study addressed 3,501 healthy middle-aged individuals without any history of cardiovascular disease who were followed for a median of 20 years.

Cholesterol and Heart Disease - A Quick Look BeyondThe authors defined levels of high LDL-C as >130 mg/dL (3.4 mmol/L), high TG as > 150 mg/dL (1.7 mmol/L), and low HDL-C as < 40 mg/dL (1.0 mmol/L).

The participants were grouped into eight distinct groups according to “normal”, or “low” or “high range” values of LDL-C, HDL-C, and TG.

The group with normal LDL-C, normal HDL-C and normal TG had a 5.9% risk  of cardiovascular events (age- and sex-adjusted 10 year CVD incidence) compared to 18.4% in the group with high LDL-C, low HDL-C and high TG.

Evidently, lipid combinations can tell us quite a lot about the risk of developing CVD.

What Is Most Important, LDL-C, HDL-C or TG?

Interestingly, low HDL-C alone or in combination with a high LDL-C and/or high TG was the category associated with the greatest risk of CVD.

When compared with HDL-C, LDL-C alone was associated with only a marginally increased risk of CVD. For example, the hazard ratio for the group with low HDL-C but normal LDL-C and normal TG was 1.93 while the group with high LDL-C but normal HDL-C and normal TG had a hazard ratio of 1.28.

In contrast to HDL-C or LDL-C alone, no increase in CVD risk was associated with high TG alone.

In my opinion, the most interesting finding of this study is that a lipid combination with low HDL-C is associated with a much higher risk than a lipid combination with high LDL-C. If HDL-C is low, it makes a little difference whether LDL-C is high or not.

On the other hand, it can be argued that lowering LDL-C with statins seems to reduce CVD risk while raising HDL-C has not been found to be helpful.

How can this discrepancy be explained?

HDL-C and Insulin Resistance

The authors of the above paper cite two recent studies that suggest that HDL-C is a surrogate marker (8,9). This may imply that low HDL-C is not problematic in itself but is associated with some other factor that can increase risk. But, where is the missing link?

It is known that low HDL-C and high TG commonly occur together. In fact, the TG/HDL-ratio (10) is strongly associated with the incidence (11) and the extent (12) of coronary artery disease.

Low HDL-C and high TG are very often related to obesity and metabolic syndrome. These situations are characterised by the phenomenon we call insulin resistance.

Insulin resistance is a condition in which cells fail to respond to the normal actions of insulin. Most people with this condition have high levels of insulin in their blood. Insulin resistance appears to play an important role in CVD and is associated with increased mortality (13).

Interestingly, previously published data from the Framingham Heart Study have shown that the risk associated with low HDL-C or high TG is increased only in the presence of insulin resistance (14) .

Another study showed the benefit of fibrate therapy was much less dependent on levels of HDL-C or TG than on the presence or absence of insulin resistance (15).

Accordingly, there is evidence that in the absence of insulin resistance, low HDL-C is much less relevant as a marker of risk than when insulin resistance is present. Therefore, insulin resistance may be the missing link between low HDL-C and the risk of CVD.

So, possibly, to reduce the risk of low HDL-C, we should aim at reducing insulin resistance instead of targeting low HDL-C in itself.

Should These Findings Affect Modern Dietary Advice?

For fifty years, dietary advice has aimed at lowering LDL-C. Therefore, a low-fat diet rich in fruits, vegetables, nuts, legumes, whole grains, low-fat dairy products, fish, and lean cuts of meat is recommended to lower the risk of CVD.

But what if low HDL-C is a stronger marker of risk than LDL-C as suggested by the above study. Should we approach individuals with low HDL-C with the same dietary approach? Is a “Prudent” low-fat diet best for individuals with insulin resistance?

Today there is abundant evidence available suggesting that carbohydrate restriction is more effective than a low-fat approach to treating insulin resistance (16).

Therefore, modern dietary recommendations have to take into account recent scientific evidence suggesting that a low fat approach may not always be the best advice to cut the risk of CVD.

Don’t misunderstand me though. I’m not suggesting we should skip fresh foods such as fruits, vegetable, fish and nuts.

However, evidence suggests we have to abandon the fat phobia, the fear of saturated fat, and the view that preferring carbs rather than fat is always the best option to reduce the risk of CVD.

But, should we abandon LDL-C and the low-fat approach? Absolutely not. There are situations when lowering LDL-C is of prime importance.

But, it is time we broaden our perspective.

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Bill M .
Guest

Interesting read, I think you’re onto something with the idea it’s insulin resistance magnifying the risks in the presence of low HDL and high TG. A couple points: “In my opinion, the most interesting finding of this study is that a lipid combination with low HDL-C is associated with a much higher risk than a lipid combination with high LDL-C. If HDL-C is low, it makes a small difference whether LDL-C is high or not.” Many vegetarians/vegans end up having low HDL, presumably their LDL is so low that they don’t need as many garbage trucks to remove the LDL… Read more »

Axel F Sigurdsson
Admin
Axel F Sigurdsson

Hi Bill You’re right. There’s evidence suggesting that plant based diets reduce the risk of CVD compared with a traditional Western dietary pattern. There may be multiple underlying mechanisms. Lowering of LDL-C may play a role as well as less risk of insulin resistance. Polyphenols in fruit and vegetables—such as vitamin C, carotenoids, and flavonoids may play a role. These have been shown to prevent the oxidation of cholesterol and other lipids in the arteries and to increase the formation of prostacyclin with positive effects on arteries and blood clotting. Reduction in blood pressure may also play a role. Fruit… Read more »

Hants Hippy (@hants_hippy)
Guest

What exactly is “A standard lipid panel” Do you by any chance mean this bunch of crooks, many of whom are paid vast amounts by pharmaceuticals to tell us to take our daily dose of toxic statins??

https://lipidsonline.org/site/editorial.cfm

Axel F Sigurdsson
Admin
Axel F Sigurdsson

No, I didn’t mean that. The term “standard lipid panel” just covers standard measurements of lipids in blood.

Judit Victor
Guest

Hi there Doc, your article is the first I read in a while. Again nothing about HeFH – we are legion and WE are the ones to look at but … NOTHING. I no longer care whether “normal” genetic markers need statins or not. Then what about US? My son at 34 got quintuple bypass surgery last christmas and it pulled the rug from under us. BOTH my boys have it. I didn’t worry because the females in my family who have it have lived longer than anyone else (WITHOUT statins on board). LCHF halved my awful cholesterol numbers, but… Read more »

Axel F Sigurdsson
Admin
Axel F Sigurdsson

Hi Judit

You’re right. I haven’t written much about Heterozygous Familial Hypercholesterolemia (HeFH). I’m sorry to hear about your problems. Maybe I’ll be able to write something on the issue but I know it won’t provide any major solutions for you.

Hopefully, the new PCSK9 inhibitors that are being tested in clinical trials will help individuals with HeFH. See here.

Judit Victor
Guest

Thank you for replying – the others without exception stay mum whenever the subject is broached. Cheers J

Rafał Bigda (fifek)
Guest

If its true what you wrote above, hen why do people with familial hypercholesterolemia, where are raised LDL levels (while remaining lipids are usually at normal levels, not low HDL and not hight TG), suffers coronary artery diseases? Why is that, since

Axel F Sigurdsson
Admin
Axel F Sigurdsson

Rafal

I never said that LDL-C doesn’t matter. Only that other measures matter as well and may even sometimes be more important or tell you more in terms of risk assessment. High LDL-C and high LDL particle number are certainly important, particularly in familial hypercholesterolemia as you imply.

JustMEinT Musings
Guest

Phew (smile) I was getting worried again NOT —— Having been diagnose with T2DM and worked at getting my BGL’s into a non-diabetic range via a LCHF lifestyle … yet still managing to give my poor GP terrible worries as my cholesterol numbers indicate a pending heart attack – I was so pleased to see the following…… Accordingly, there is evidence that in the absence of insulin resistance, low HDL-C is much less relevant as a marker of risk than when insulin resistance is present. Therefore, insulin resistance may be the missing link between low HDL-C and the risk of… Read more »

Axel F Sigurdsson
Admin
Axel F Sigurdsson

Thanks C
Appreciate your interest.
Sincerely hope your health keeps improving.
Keep up the good work 🙂

Kjartan L
Guest
Kjartan L

As a medical doctor specializing in family medicine (GP) I can assure you some of us are picking up on this “new” trend and looking into LCHF. There are very convincing studies that show greater effect treating DM2 (and as a supportive treatment of DM1) with high-fat diets while restricting carbs. We are spreading the word, but old habits die hard. Best regards.

JustMEinT Musings
Guest

[reply] I am happy that some GP’s are finally looking at Low Carb Healthy Fat Lifestyles as a way of putting into remission DM…. must just be the Aussie ones (some of them) who are behind the eight ball as it were :-)…. he is happy BGL numbers are into the ‘healthy’ range and horrified LDL is too high (must be the fats!)….. Cannot even relate to nice healthy NORMAL triglycerides as they seem locked into the TC and LDL numbers down here….. Congratulations on being more up to date and spreading the word.

Walter Rice
Guest
Walter Rice

Doctor Sigurdsson, I have had low HDL-C (29-40) for over 20 years but it was never highlighted as a real concern since my total cholesterol has ranged from 95-114 and TG from 85-106. However, I had a lipid panel run this past December and my PCP suggested a statin drug since my HDL-C was 35. My lipid panel was: Total Cholesterol 114 Triglycerides 106 HDL 35 LDL 58 VLDL 21 T Chol/HDL 3.3 Non-HDL 79 Your article states “low HDL-C is much less relevant as a marker of risk than when insulin resistance is present”. I do not have any… Read more »

Jon Grant
Guest

Hi Walter, I hope you don’t mind if I jump in here. Do you take fish oil or astaxanthin? Both of these can increase HDL and also reduce triglycerides. 10g of fish oil, and 12mg of astaxanthin have increased my HDL from 47 to 64. My TG has gone from 147 to 98.

Walter Rice
Guest
Walter Rice

John, Thanks. I have just recently started 1000 mg of fish oil tablets per day. I will certainly try astaxanthin. Any particular brand? I appreciate your comments.
Walter

Axel F Sigurdsson
Admin
Axel F Sigurdsson

Hi Walter

In fact statins do very little for HDL-C. Your LDL-C is very low. It is unusual to prescribe statins if LDL-C is below 70.

How do you know you don’t have insulin resistance?

A TG/HDL-C ratio above 3 may suggest insulin resistance, but it doesn’t have to. Have you had Hemoglobin A1c tested? Do you have central obesity or any other signs of metabolic syndrome?

Walter Rice
Guest
Walter Rice

Hi Doctor, Thanks for responding! I do not see Hemoglobin A1c on any of my blood tests. My Glucose Serum has run 79-84 in the past. My BMI is 28, not good but not obese and my stomach does not look like the photos I see for central obesity. My TG/HDL-C ratio has run from 2 to 3.02 on previous tests. I had a banana just an hour prior to my recent lipid panel. Could that have had any effect on my results? Can my PCP do specific insulin resistance testing? Would the Thallium Stress test in 2010 have shown… Read more »

Axel F Sigurdsson
Admin
Axel F Sigurdsson

I agree Walter. I think your lipid profile is low risk. Total cholesterol is low, LDL-C and Non-HDL cholesterol are both low. Yes a normal Thallium stress test should indicate that there are no narrowings/blockages in the coronary arteries.
Best of luck.

Eliot
Guest
Eliot

I think Framingham Offspring data showed that LDL-P is more important than LDL-C. I saw a survival graph where, after 18 years, the highest survival rates were with low LDL-P and either high or low LDL-C. The worst survival was for high LDL-P and low LDL-C. I will try to find the reference.

Eliot
Guest
Eliot

Here is a link to the study. Look at Fig 2. (I don’t know how to post it here.)

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2720529/

Correction: It was 16 years, no 18. And notice the sharp drop-off during the last year for high LDL-P/low LDL-C.

Axel F Sigurdsson
Admin
Axel F Sigurdsson

Hi Elliot

Thanks for the comment. Actually I did cite the study in another article.

Interestingly, TG/HDL ratio may help predict LDL particle number as discussed here.

Eliot
Guest
Eliot

“On the other hand, it can be argued that lowering LDL-C with statins seems to reduce CVD risk while raising HDL-C has not been found to be helpful.”

I cringe whenever I read statements like this. It can only be argued that taking statins seems to reduce CVD risk. It might be due to lowered inflammation, decreased endothelial dysfunction, stabilization of vulnerable plaque or some other beneficial side effects of statins.

Axel F Sigurdsson
Admin
Axel F Sigurdsson

Hi Elliot

You’re right. It has been debated how much of the effect of statins is due to lowering of LDL-C and how much is through other mechanisms. The recently published IMPROVE-IT trial suggests that lowering of LDL-C will reduce risk further among patients with coronary heart disease who are already on statins.

Mie
Guest
Mie

No, he really isn’t. A statin that lowers LDL-C more than another statin is more effective in reducing CVD events. The pleiotropic effects are totally secondary. See e.g. https://www.ncbi.nlm.nih.gov/pubmed/16286171/ Concerning the HDL “paradox”: a very good post Axel! In addition, I’d like to point out that e.g. your reference 9 (its Table 1) shows more or less why HDL-C lowering hasn’t been that much to talk about: – the effect of lifestyle interventions on HDL-C is minuscule – thus, no benefti to be expected – the effect of drug treatments mostly too, with the exception of torcetrapib – and in… Read more »

Eliot
Guest
Eliot

[I don’t see a reply button for Mie’s post so I’ll put this here] “No, he really isn’t. A statin that lowers LDL-C more than another statin is more effective in reducing CVD events. The pleiotropic effects are totally secondary.” A statin that lowers LDL-C more than another statin might also have stronger pleiotropic effects. The study mentioned looked at “5 diet, 3 bile acid sequestrant, 1 surgery, and 10 statin trials”. It is possible that bile acid sequestrants have similar pleiotropic effects as statins. I don’t know the details of the diet studies but they might have some other… Read more »

Axel F Sigurdsson
Admin
Axel F Sigurdsson

Eliot.
The replies can only go three levels deep. Then the reply button disappears.
The best thing is to reply to the comment Mie replied to. Then your comment will appear below his/hers.
Remember to scroll down a bit to find the text-box after you push the reply button.

Toque
Guest
Toque

Thanks for another interesting post. Your #7 reference is particularly interesting. A significant (but as far as I know, unknown) proportion of folks on a low carb diet present with very high LDL-C/LDL-P but typically low TG and high HDL. Do you know of any studies that grouped participants to shed any light on those sort of folk?

S.
Guest
S.

I find the opening paragraph very offensive…. likening cholesterol to something so pretty… Im struggling with obesity and its consequences… Its no walk in the park and theres certainly nothing pretty about it. I hope you will consider more carefully which words you use in the future..

Axel F Sigurdsson
Admin
Axel F Sigurdsson

Really sorry to hurt your feelings. I would never have imagined this paragraph could be offensive. Anyway, maybe you’re just joking. That’s fine with me. But if not, please accept my apologies.

But look at it this way. Cholesterol is just a part of nature. It’s essential for human life. It’s part of our cell membranes and without it we wouldn’t exist. So cholesterol is just a part of nature. Like the sun, the moon and the stars. So, it can’t be all that bad can it?

Judit Victor
Guest

I don’t thnk you’ve said anything offensive Doc at all. My gripe was only that doctors never cover HeFH and I can understand it fully since it is so cery complicated. Obese is obese. My old mother of 83 has a natural cholesterol of 13 (we inherited the gene from my side of the family) the women live very long but the men.. well my heart just goes into a fast beat when I mention it. I am terrified for my beautiful sons. BUT, on ketosis it my cholesterol came down from 13 to 6, period. NOT a single cardiologist… Read more »

Raymund Edwards
Guest

Most low carbers get Triglyceride well below 150 ! Mine sits at 50 to 70 with HDL up near 70 I would also consider Trgs at 150 way too high for anyone on a LCHF lifestyle . So it would have been very interesting to see the numbers rerun with a lower cutoff for triglyceride. High HDL with Trgs at 70 or below then possibly even more significant than when Trgs are only 150 or below. Trgs at 70 or below could also then start to be a significant factor on there own too. When I see people with Triglyceride… Read more »

Judit Victor
Guest

but but but, your LDL goes large and bouncy so it doesn’t matter, although mine fell right down on ketosis. In metric also my trigs came down to 0.7 and I am also genetically hypertrigliseremic (spelling??). Have to somehow get back onto LCHF, but I find it slightly cruel, though easy to maintain. Guess what, EYE bake wedding cakes for a living. oh sigh…. If you have your LDL mri-ed and you’re on LCHF you will find the molecules lovely and big and non sticky.

Erik Arnesen
Guest

I’m sorry, but even if large LDL particles were less atherogenic, they would not be non-atherogenic. They are still small enough to deposit in the arterial wall. See the National Lipid Association’s “Clinical utility of inflammatory markers and advanced lipoprotein testing: advice from an expert panel of lipid specialists”: https://www.lipid.org/sites/default/files/articles/expert_panel_paper.pdf.

Anyway, you don’t necessarily need to go on a LCHF diet to reduce small, dense LDL’s (“A simple change of ≈25% of energy load from fat to carbohydrate in a meal significantly improves postprandial pro-atherogenic factors in obese boys.”: https://www.sciencedirect.com/science/article/pii/S0939475311000032).

larry ulsh
Guest
larry ulsh

purely anecdotal I know, but my 83 year old mother was diagnosed with breast cancer 15 years ago. She ate mostly carbs and vegetables at the time. She was typically not feeling well, bloated and tired. Once she went through chemo, her diet changed. She experienced chemo related problems including a fast heart beat and some minor kidney issues. By changing her diet and taking supplements for her heart, she is as healthy I have ever seen her. If you peak into her refrigerator, all you will see is eggs, butter, cream and chicken salad. Fish and some veggies are… Read more »

Christopher palmer
Guest
Christopher palmer

Ding dong! [merrily on high, the truth is now emerging.] Online grocery shopping is all the rage, and home delivery no truly commonplace. The goods in those shopping bags travelled many hundreds of miles, probably, some by air, some in shipping containers, many by road in refrigerated big-wheeled articulated lorries, and finally it came from shop to your door in the kind of van frequently termed a ‘transit’. The way goods are transported, and the type of vehicles used, has to reference the network routes they may follow, and the kind of access at the various ‘nodes’ where they may… Read more »

Axel F Sigurdsson
Admin
Axel F Sigurdsson

Richard.

“Incoherent” is the word that comes to my mind when reading this comment. I have no idea what you’re getting at. I’m probably stuck on that fence as you say. You’re not the first one to tell me about my limitations.

I’ll let the comment stand for a while in case someone else makes any sense out of it.

Judit Victor
Guest

Haaa ha ha ha I was also wondering about this comment – is it someone very angry or cynical or frustrated. BUT, did make me smile.

'Dick' (a commomplace shortening of the name Richard)
Guest
'Dick' (a commomplace shortening of the name Richard)

“I have no idea what you’re getting at .. “ Then why not read Peng and Morins book, ‘ Biological Effects of Cholesterol Oxides’ [3] to bring yourself up to speed? Why not acquaint yourself with some of the steps in the history of the formation of the cholesterol hypothesis? And why not simply visit an online encyclopedia to reacquaint yourself with the acetyl and mevalonate pathway and its perceived pertinence to the primary prevention of cardiovascular disease? Why not have a fresh look at what a lipoprotein is and what it is comprised of? Then wonder if something riding… Read more »

Mark Buster
Guest

Insulin resistance usually results in more insulin circulating, why do you say insulin resistance is a risk and not just excess insulin? I am T2D on LCHF and in nutritional ketosis, my insulin levels are low. Dietary ketosis results in insulin resistance too. Are you suggesting I’m more or less at risk just based on this. Does the fact that my HDL/Trig ratio is ~1 influence your opinion?

Axel F Sigurdsson
Admin
Axel F Sigurdsson

Hi Mark

Increased insulin production is a reaction to insulin resistance. When the cells of the body become resistant to the action of insulin, the pancreas starts to produce more insulin in order to solve the problem (compensatory hyperinsulinemia). This is typical for T2D although insulin production usually diminishes again as time goes on.

Dietary ketosis will likely reduce insulin levels because less insulin is needed because you’re not eating sugar or carbs. A TG/HDL ratio of 1 is good (if you’re using US units) and doesn’t suggest insulin resistance.

Mark Buster
Guest

Thanks for the reply and another great post.

Would eating less than 30 grams of carbs per day for 2 years, mask any signs of being insulin resistant?

Eliot
Guest
Eliot

Mark,

Just saw where vitamin A increases beta cells in mice. Might be worth a try if you think you are not getting enough A..

https://www.medicalnewstoday.com/articles/288199.php

'Dick'
Guest
'Dick'

“is it someone very angry or cynical or frustrated. BUT, did make me smile.” Happy to have raised a smile. In reality it was the work of pragmatist thoroughly frustrated at the persistence of dogma. The tone was intended to be encouraging. That’s to say it was intended to be appreciative of Axels additional steps that have him trending away from the dogma as resides in medicine. Medicine and medical science is great. Medicine can work wonders. Axel is great. Axel is great because whereas most of his colleagues are very conservative he is openly progressive. Evidentially, the cholesterol hypothesis… Read more »

Judit Victor
Guest

Realised that full well. Has he tried the banks yet – those arteries are clogged inside AND out, same as home affairs.

Axel F Sigurdsson
Admin
Axel F Sigurdsson

Dear Christopher (Dick)

I’m really sorry for the name confusion. It was purely unintentional . Probably a Freudian slip. Lengthy comments from one Richard (OrnishForLife) surfacing from my subconciousness. Can’t explain it otherwise.

I do appreciate your interest in my blog, don’t misunderstand me.

I also realise you’ve studied these matters a lot.

However, I prefer short comments and they should also be related to the blog article at hand.

I usually reject long essays that are out of context.

Hope you continue visiting the website and I hope you’ll respect my policy regarding comments.

Best wishes
Axel F

Nick
Guest
Nick

Hello Doc, I have CAD and had a stent placed about 11 years ago. I’m male 65 yo mean BMI and very active. I found out my FBG @112 was slightly elevated just over a year ago. Without medical intervention I researched this relentlessly and decided to eat LCHF. I lost 18 lbs., increased my HDL, also my LDL slightly, slashed my TG and VLDL. I’ve been eating LCHF for about a year now, have tons of energy, feel terrific, I do strenuous hikes in the mountains weekly, work full time, and my heart health actually feels better, no bloating,… Read more »

JJWMS
Guest

I am a 60 year old male on LCHF for 1 year, BMI of 20, LDL 298, HDL 58, Trig 130. Should I go on statins (again) to reduce my LDL, or not. Muscle aches were an issue previously, on simvastatin.

RichardOrnishForLife
Guest
RichardOrnishForLife

Doc,

see the new study which (again) highlights the issue of cumulative burden when it comes to LDL. Even modest elevation of non-HDL cholesterol at early adulthood is associated with elevated risk later on. This is an issue which you seem to overlook again and again.
https://circ.ahajournals.org/content/early/2015/01/15/CIRCULATIONAHA.114.012477.full.pdf+html

Martin B Katan, reknown Dutch epidemiologist explain why it is hard to take seriously the new studies allegedly casting doubt on saturated fat:
https://www.cspinet.org/nah/pdfs/covermay2014.pdf

Best,
R

Axel F Sigurdsson
Admin
Axel F Sigurdsson

Thanks. No, I don’t think I overlook the issue, at least not all the time, see here and here.

RichardOrnishForLife
Guest
RichardOrnishForLife

So, Doc,

what you are goin’ to do with your next FH -case, encourage the patient to increase his/her SFA intake and initiate a therapy targeting his/her blood-glucose levels?

LOL! Doc, I think you are a fucked-up denialist fraud, akin to people who promote Intelligent Design.

Judit Victor
Guest

You are rude Sir. I have HeFH and an EXTREME Keto diet (very high in sat fats) halved my cholesterol – I reckon I was the first one in the entire world who, for my children’s sake tackled the diet and thought “if I die they need to know it’s the diet” and I would’ve died quickly since our types’ arteries clog up very quickly (though not in females for some reason). Thus I eat fat chops (unfortunately I don’t eat pork), beef, lots of butter, double cream only, etc. Would you tell those mothers whose epyileptic children benefited from… Read more »

Axel F Sigurdsson
Admin
Axel F Sigurdsson

Richard
I’ve been forced to not accept some of your comments lately.
I’ll let this one stand as a token of your attitude.
Otherwise, I will not accept impolite or rude comments. Lengthy posts that are out of context will also be rejected.
Best wishes
Doc

Eliot
Guest
Eliot

Good choice Doc. I think Richard needs to work on his Ornish meditation, otherwise he might blow an artery.

Judit Victor
Guest

Again, Mr. RichardOrnishForLife, my mother is now 83. Only found out she carried the gene in her sixties – couldn’t tolerate statins at all. She outlived all 11 of her siblings. 2 of her brothers unfortunately carried the gene and died young. None of her other siblings (sans the two brothers) carried the mutation. The others had such very low cholesterol numbers and yet they died of diabetes. Both my sons carry the gene and I don’t care if the whole world swears at me – my sons need to beat this thing and they ARE too!

Sherif
Guest
Sherif

Hi. I am a 51 year old male. I am a non-smoker. Had a blood pressure of 145/100 for the last couple of years without medications. One month ago, my blood pressure read 160/100. I decided to visit a cardiologist after checking my lipid profile. The readings were: T. Cholesterol: 260 mg/dl Triglycerides: 94 mg/dl HDL Cholesterol: 50 mg/dl LDL Cholesterol: 191.2 mg/dl The cardiologist prescribed a blood lowering medication, a statin (Crestor) and daily pill of baby aspirin. Starting taking Crestor for a couple of days made me feel terrible and decided to stop it; however the doctor says… Read more »

Rob Smith
Guest

Very nice article and exchange of opinions… Very helpful thoughts specially for those who has cholesterol and heart problems but without enough information regarding their condition and doesn’t have proper knowledge in Healthcare.

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