Cholesterol Report Tool

I found this kind of interesting…probably most of us know our standing already anyway. I was in the lowest risk, but I already knew my numbers would put me there.

The importance of cholesterol numbers and statins is becoming a debated issue now anyway.

This test puts me at lowest risk. Most of these tests ask if you have diabetes or heart disease. Since I do, I would probably be high risk.

Most do, that’s true. It does say it’s under construction, maybe they will add to it.

Cholesterol has a tremendous amount of variables and risk from cholesterol indices can vary dramatically from one person to the next. I had never paid much attention to my numbers as in the past years my LDL had been steady at 70 with 40 mg statin and 70 or under is what my endo requires to keep her happy. We can endlessly debate the validity of her line in the sand, but after being on low carb diet for over a year my LDL rose to 93 and she said either get it back down to 70 or less within 90 days or she will raise my statin to maximum allowed which is 80 mg.

I started working on this 3 weeks ago and test my cholesterol every Saturday morning 6 AM after a 12 hour fast and am amazed how much my numbers vary based on diet and exercise. Within 2 weeks I was able to drop LDL to 62. Tomorrow morning will be my 3rd Saturday test and will see where LDL lands.

My ultimate dream is to be able to drop my LDL low enough to be able to go totally off statin, stay low carb diet and still keep my endo happy. My initial experiment looks very promising, but way too early to tell if a continued drop is possible, sustainable or if I am just experiencing some sort of beginners luck.

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This tool was created by Dave Feldman, a low carb eating advocate, and someone who has conducted countless blood tests on himself to test hypotheses on the relationship between eating and lipid measurements.

His background is in engineering, not medical science. But I don’t hold this against his work.

I input my lipid numbers into this tool and found I was in the green zone for all three risk reports. My cardiologist would wholeheartedly disagree with this assessment but I find Feldman’s tool more credible.

I do have coronary artery disease, however, as measured by a coronary artery calcium CT scan. The one-year follow-up scan shows that my disease has stabilized, a result that came from a comprehensive lifestyle program that I believe was much more effective than taking a statin. I eliminated all grains in my diet as one measure. Most coronary artery disease progresses at a rate of 20-30% per year. Mine dropped by 2%.

I have a total cholesterol of 226 mg/dL and LDL of 153 mg/dL, both of these number are objectionably high when considered by traditional clinicians. My triglycerides come in at a low 62 mg/dL and HDL at a strong 61 mg/dL.

When I met with the cardiologist to review these numbers, he was totally unimpressed with my triglycerides and HDL, while he viewed my total cholesterol and LDL as troubling.

I don’t believe that high cholesterol causes heart disease but it may indicate an underlying factor that is causal. I think future generations will look back on this era of cholesterol hysteria and the corporate fortunes made on statins and just shake their heads.

I realize that my position is controversial and I don’t state it simply to stir up conflict. I have no credentials or expertise to back up my opinions. I have, however, spent hundreds of hours reviewing the literature, read with the focus of someone who has skin in the game.

I do think there’s some truth in Dave Feldman’s beta cholesterol tool but you won’t find many clinicians who put much stock in the underlying concepts.

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My past GP and endos before haven’t bugged me at all, my new endo hasn’t said anything either, just my new GP that thinks every diabetic should be on a statin no matter what. My Cholesterol is 176, LDL 83, HDL 76 and triglycerides are 90. But I have been a vegetarian for over 50 years and a vegan for 35 years.

My new GP and me have come to an agreement, she can keep asking and I will keep saying no lol…

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Years ago I asked my endocrinologist why cholesterol was considered an “endocrine” problem (The heads of a huge Lipid Research Clinic in our area was endocrinologists not cardiologists). He said way back, cardiologists didn’t think cholesterol had anything to do with heart disease so they were never interested in it. They discovered otherwise and then cholesterol started mattering to cardiologists.

Couple of interesting points, most often doctors test a calculated LDL, a calculated LDL is just as it implies- calculated. This is done by subtracting the V-LDL (very low density lipoprotein) and the HDL from the Total cholesterol. The VLDL is determined by by dividing the triglycerides by 5. This method is an estimation because it’s accuracy depends on other parameters, like the triglyceride levels. The accuracy of this method decreases if the triglycerides are above 200. IF they are above 400, the formula fails completely. It is said that the calculated LDL is underestimated in diabetics (why, I don’t know) and your’s inacurrate if you aren’t fasting because the triglycerides are extremely sensitive to fasting state.

There is a better test available, the direct LDL. It is much more accurate and doesn’t involve the triglycerides in calculation so you don’t necessarily have to be fasting.

The other test of importance is the LDL particle number. There is a test through LapCorp called an NMR that does the particle number. The studies have shown that the LDL particle number is the best number to indicate cardiovascular risk. Framingham Offspring (which is a study with a lot of clout) showed that there was significantly lower cardiovascular events with lower LDL particle number (59 per 1000 person years) compared to those with equally low levels of LDL-C (81 per 1000 person years). You can have a normal (or even low) LDL cholesterol level but still have an elevated LDL particle number.

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Your position is less and less “controversial” every day, Terry. What did your cardiologist think of the particle numbers, if you had it done?

Peter Attia breaks down nicely how to understand cholesterol after a particle number test, it’s a bit more complicated than it would at first seem.

I have had the particle test performed twice. My cardiologist won’t pay any attention to my low particle numbers. He said that he used to but no longer thinks the test has much value. This guy is very intelligent and is in his 40’s.

He is still a big believer in using statins and getting the LDL numbers down. He said that having lower LDL numbers is what he has seen work for his patients.

I definitely was not a believer in the push for low LDL numbers especially since I can’t take statins. I was well acquainted with opinions on both sides of the issue and chose to believe that the LDL number didn’t matter as long as trigs were low and HDL was high. I ended up with two heart stents.

I am still not taking statins and can’t seem to get my LDL number under 114 with a rigid low fat plant based diet. When I received my stents my LDL was in the 160’s, my HDL was about 100 and my A1c was 4.6. I was eating 30 carbs daily and had been for several years.
That was in 2010 after having had diabetes for 51 yrs. I appear to be holding up quite well after having recent tests, even though I am not on a statin. I am considering starting the injectable cholesterol medicine although I don’t want to.

I had the NMR LipoFit panel run that did include particle numbers. Here’s the LDL particle number portion of that panel.

One year prior, my LDL-P number was 2430 nmol/L, so this most recent test showed an almost 30% drop in LDL particles. My small LDL-P, the more atherogenic component, was under the standard range.

My heart doc had no comment on the particle number. He intently focussed on LDL-C at 153 mg/dL as the over-riding and determining factor of his analysis. I raised the fact that my LDL-C dropped significantly (226 => 153) in the intervening year and suggested that this would be a positive point, especially from his perspective. This fell on deaf ears.

I consider his analysis short-sighted, distracted, and overly influenced by one aspect of cholesterol.

It was not a pleasant visit. At one point he asked me why I was so cynical and I responded that he should not dismiss my skepticism as cynicism. I don’t think I will willingly consult with him again. The only reason I did the face to face meeting was to reciprocate and recognize his willingness to order the lipid panel for me.

I don’t know why any patient needs to go to a provider, hat in hand, to get the data the patient needs to monitor a vital life function. I don’t have unlimited financial resources and Medicare will not pay for these kind of blood tests unless ordered by a doctor.

Now, I realize that I am not a typical patient and I think this doctor is confused by my behavior, awareness of the medical literature, and contrary position. I’m sure he did not enjoy the interaction, either.

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I am now 3 weeks into working on lowering my LDL through modification of daily exercise and food to satisfy my endo that insists it be 70 or lower or else she will increase my atorvastatin from 40mg to 80mg and am surprisingly seeing rapid weekly improvements well beyond my expectations. My ultimate goal is to totally get off of my statin and if I continue to see the kind of improvement experienced in the past 3 weeks, that is starting to look possible. July and December 2019 were taken at Joslin and the next 3 tests were self tests at home.

Jan 4, I had wicked headaches all week (resulting very low HDL) and realized that additional exercise created a shortage of sodium electrolyte even though I was drinking a 20oz PowerAde zero on a daily basis. At least 1 cup of chicken broth a day with 3/4 tsp sea salt immediately turned that problem around. If my LDL continues to drop or stay at the current low level for the next 2-3 weeks, I will go have a lab test to confirm my home results and then start cutting my daily 40mg Atorvastatin to 20mg.

I am just blown away at how fast cholesterol numbers can change with some repeated pretty minor tweaks. My results so far are:

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Please keep us posted.

Have you considered having blood drawn for lab analysis and doing a concurrent “home test” so you can compare the results?

Yes, of course. I could not do that in the past as I did not have the equipment on hand. Joslin requires a lab report in hand by March 5th 2019. I am planning to continue home testing every Saturday at 6 AM. As soon as my home numbers start to stabilize, if within the next couple of weeks, I will go for a lab test with a concurrent test. At worst case that will happen by March 5th. I would like to go earlier if stable so that I can start cutting up my daily pill and take less.

I am sure the lab will have a good chuckle when I show up with my equipment, pipettes, etc. It takes about 7 times more blood for a cholesterol test than it does for a BG test, so the blood draw alone is a bit lengthy in comparison.

My results will continue to be posted here unless people get tired of seeing them and will answer any questions about how my results are achieved. For now I am just looking to continue trending down or stabilizing a low LDL and then when stable confirm with lab doing a concurrent test each lab visit.

I would like to know what you find out, because I can’t get below 114 without a statin, and I would love to see a lower ldl. I recently raised my thyroid dose and hope that my ldl level will fall because of normalization of my thyroid levels.

It is going to take a while to figure that out because normally I only test 1 variable at a time. That was not possible in this case as I need to be able to show total corrective action within 12 weeks so I am currently working on 6 variables and then when my numbers stabilize, will reduce variables 1 by one to see which if not all are the most effective. Current variable are:

  1. daily exercise from Winter sedentary to 20 mins treadmill 5 days a week at about 85% HR
  2. Fasting hours before test. Starting at 12 hours and will go down to 8 and up to 16 hrs
  3. Cut out 80% + of saturated fats.
  4. Optimize Sodium intake to minimal possible level
  5. Hydration level 12 hrs before test 8/16/24 oz water
  6. 1200 mg+ daily polyphenols
  7. Eating low tot carb (less than 30g per day).
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Keto and ME/CFS (Part III): lipid models and the lean mass hyper-responders.

I think we have to be very careful with Cholesterol control just like we diabetics are with Blood Glucose control. There is a lot of information that has been coming out for years and keeps coming out to justify or vilify high LDL as well as justify or vilify the use of statins at any level.

Many of us have been following the work of David Feldman, David Diamond, Peter Attia, Paul Mason and others who are on the get off the statin band wagon. It is important that we first realize that as diabetics we are in a special group of people at generally higher risk of Cardio vascular disease than the the general non-diabetic population as there is a direct link between elevated blood glucose levels and Cardiac events.

We can listen to these doctors that oppose statins and they make great arguments that statins in general can do more harm than good but we must remember that we are not “in general”, we are diabetics. David Feldman has been doing great work as well but we need to remember that he is not diabetic (although pre-diabetic) and he is a lean mass hyper responder which most of us are not either. That does not make his analysis invalid, but needs to be weighted, just like studies funded or put out by the pharmaceutical industry need to be accepted only after doing a deep dive into how they arrived at their claims.

The more I get into the weeds with controlling my own cholesterol issues as much as possible naturally and as little as possible with a statin, I realize that what will work for me, will work for other diabetics in a similar situation, but certainly not for all. I would highly recommend for anyone interested in this subject to view the following YouTube video by Dr David Diamond who basically says that keeping Cholesterol under control should lean more toward lifestyle changes which in turn allows less to no or lesser reliance on statins.

My diabetes is wonderfully under control but my LDL is climbing out of acceptable range for a diabetic. I am not here to argue if elevated LDL is or is not a risk for diabetics but am weekly testing my cholesterol and finding that with minor lifestyle tweaks I can dramatically reduce my LDL which in turn should allow me to reduce or if lucky even totally eliminate my use of a statin. My initial exercise is just to bring my LDL through diet and exercise to the lowest possible level and reduce my statin accordingly. Once I plateau at the lowest level I can maintain, then will work on changing the distribution of LDL particles from atherogenic small LDL to larger LDL particles, and shifting small HDL particles to large HDL particles as and if required.

The following video by Dr David Diamond is both entertaining as well as very informative without getting too deep into the technical and biomedical weeds. I hope you enjoy it as much as I did and I also hope that other diabetics in a similar diabetic situation as mine (low BMI, non smoker, low carb, over 70 year old male etc.) will be able to take advantage of some if not all of my findings on my own research which will be posted in this thread with up dates every few weeks.

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I agree with @CJ114, right now the safest course seems that especially for a diabetic to keep down your LDL levels but also to keep HDL at higher levels.

Life Extension Magazine has a couple of really good cholesterol articles. Life Extension is a well respected group of doctors in the health/supplement field and has a tendency to stay up on the" latest". They sell supplements and blood tests so of course they want to sell their product, but their monthly magazine would always announce some of the latest findings and research.

The first article was published in 2009 and gives a brief history of cholesterol beliefs. The second article is a more up to date and explains the use of cholesterol in the body etc. Much more technical information but it also talks about supplements and if you’re not interested just skim past it because it talks about how cholesterol is used in the body and is very informative.

https://www.lifeextension.com/magazine/2009/2/the-cholesterol-controversy

https://www.lifeextension.com/protocols/heart-circulatory/cholesterol-management

Yes, Terry and my Home Testing is pretty much in line with Lab results. My LDL-C dropped from 95 mg/dL to 59 mg/dL by working on it for 8 weeks. Attached are my weekly results, as well as my blood test lab report. A few surprises, phenotype B pattern and some fractionation LDL results a bit out but my mind was totally blown at hsCRP >10 mg/L with no known Inflammation or infection.

image

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