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.
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.
So, you kept up with 40 mg atorvastatin throughout this test? And you exercised 5x/week, kept your carbs at 30 grams per meal while only eating one meal per day yet also keeping saturated fat to a minimum. Did I get all that right?
I am wondering why you didn’t get an NMR lipid panel that shows particle counts and measures the actual number of LDL particles instead of using an equation to calculate them.
While it’s impressive that LDL-C went down from 95 to 59 mg/dL, the small dense pattern B is concerning, although, at the low levels measured, maybe LDL size does not matter. On the bright side, your triglycerides dropped from 96 down 63. I see your HDL also dropped but was still landed at a decent level of 59. Your triglyceride:HDL ratio, at 1.07, is desirable. In fact, the last Quest test put that ratio at 0.74, an ideal result.
I would just get the hsCRP tested again as that looks like a total outlier considering you detected no inflammation symptoms.
Are you going to try to reduce your statin dose to see what happens? I’m curious to hear what your doctor concludes from this, if you don’t mind sharing.
I agree that we diabetics are not in sync with the general population but I think people like you are not in sync with the entire diabetic population. I remain skeptical of using statins to depress LDL under some arbitrary level but a small part of me wonders about the so-called pleiotropic good effect that statins might have in fighting cardiovascular disease.
Interesting comment; keep up the good work.
So, you kept up with 40 mg atorvastatin throughout this test? And you exercised 5x/week, kept your carbs at 30 grams per meal while only eating one meal per day yet also keeping saturated fat to a minimum. Did I get all that right? - Yes that is correct and when you look at my weekly home testing you will see some variations as I tested different foods, polyphenols, Chromium Picolinate (See other thread) and increase in Vitamin C/E as well as different levels of hydration. Each one of these takes some explanation but my post was long enough as is for starters.
I am wondering why you didn’t get an NMR lipid panel that shows particle counts and measures the actual number of LDL particles instead of using an equation to calculate them. - I did not go the NMR route because NMR/MRA, GGE, VAP tests are all based on relative concentrations which are good but I don’t totally trust. My results were done by Quest using ION Mobility test which are the actual numbers without any calculations using absolute concentration which should be more reliable. We can explore this further but here is a quick basic read:
the small dense pattern B is concerning - Yes, that is the most concerning LDL indice along with LDL Peak size but I think in time that can be managed into tolerance over time. I just had to throw everything I could at my LDL-C to keep my doctor from increasing my statin from 40-80mg and since I easily beat her 70 mg/dL requirement, I have advised her that I soon plan to cut my dose from 40mg-20mg and then re-test in a few weeks.
I’m curious to hear what your doctor concludes from this, if you don’t mind sharing. - I sent all my results including home test and Quest to her this morning and should hear back early next week and of course, I am always willing to share anything that might help this community that has helped me so much in our united goal to help each other improve where able. I also always post my profile stats because that gives an individual a better idea if what I try may be applicable to him/her.
I would just get the hsCRP tested again as that looks like a total outlier considering you detected no inflammation symptoms. - This one freaks me out so probably will re-test within 1 week - 10 days.
I remain skeptical of using statins to depress LDL under some arbitrary level - I totally agree and believe there are no studies that show a decrease in LDL-C actually has more than a very minimal possible impact on LDL-P. That is the next test I proposed to my doctor to cut my statin from 40mg-20mg and look at the resulting changes in LDL-P. My guess is that LDL-P will not noticeably be affected and the statin industry knows this so kept that information to themselves in order to keep pushing the LDL-C relative risk looking good for their product sales. Their all cause mortality results don’t support taking statins for most patients which is why we don’t see much of any trials after the September 2004 legal changes in how trials are done and supported.
I also agree that for some patients pleiotropic effects kick in which is why you can’t just say don’t take statins.
My long term goal, as in the next 6-8 months continues to be to totally eliminate my statin while at the same time reducing cardio vascular risk. The problem is mostly that statins are promoted as one size fits all and even more than YDMV, cholesterol has even more variables. What I have also learned in this process is how closely Blood Glucose relates to Cholesterol and the importance, I believe, of standard deviation as it appears that the nasty small dense particles reek havoc every time BG rises rapidly which is what I am testing with flatlining after meal(s) see:
CHROMIUM PICOLINATE FLAT LINES AFTER MEAL SPIKE
Congratulations on your LDL drop CJ. That is impressive! My last week numbers are LDL 116, Trigs 57, HDL 57. My cardiologist thinks those are fine numbers for a non diabetic, but not for a diabetic with 2 10 yr old stents.
He thinks that I am a walking time bomb. He doesn’t pay attention to my 20 yr period of non diabetic A1c’s. Maybe partly because my A1c was 4.6 when I suddenly needed stents.
He thinks I am foolish to not take REPATHA. I have studied the conclusion of the 3 yr study on this drug and the results were very disappointing. I have read and watched everything I can about Repatha. He would not believe that the drug only helps one out of 69 people. He didn’t believe the statistics that I found showing that this isn’t a great drug. He couldn’t tell me if the drug reduces inflammation.
I said that I wasn’t sure nor were many cardiologists whether having a low LDL for many years would be healthy for other parts of my body. He believes that a LDL of 30 would be ideal. I said that I don’t want to take such a new drug and he said that it was approved by the FDA. I laughed.
I am making myself sick over this decision. My GP doesn’t think I should take it if I am not comfortable with the idea. He definitely thinks that an LDL of 30 is way too low. He said that his partner who is a huge fan of statins, recently went to a medical convention in San Francisco where it was stated that it has been found that statins increase the life span by 30 days.
My husband will be seeing this doctor very soon and since my husband is on statins, he is going to ask to be taken off statins even though he has high LDL. Statins have increased his glucose levels. But because his doctor was such a fan of statins, my husband stayed on them. I will get the name of the convention that this doctor attended and find out more about the study.
I recently remembered that not only did my grandfather have a stroke or heart attack that killed him in his 60’s, but my father had a slight heart attack in his mid to late 60’s. He immediately stopped eating fat and lived until he was 89. I don’t know if not eating fat had anything to do with his longevity. He never ate junk food in his life.
I exercise an hr most days, weigh 105, rarely eat anything processed, eat vegan and low fat. I can’t seem to get my LDL any lower with out statins. I can’t take statins nor do I want too. I also don’t want to die any time soon.
I really admire all the work you do CJ to track everything.
Marilyn,
What was your cardio-related diagnosis before and after you got your stents? I ask because I see you referring more to the fact of the stents rather than the underlying problem they were placed to correct. That’s the part that I don’t have a good sense of. Obviously, stents are meant to correct blocked arteries. I’m trying to remember - and maybe you’ve said it already, I apologize if so - which ones and how much they were blocked. I vaguely recall your mentioning something about presenting with some very concerning symptoms just before the stents were placed, but I’m not quite certain of the details. Question: was LDL your only risk factor, at that time, aside from T1D? Did you also have uncontrolled hypertension at the time, and if so for how long?
On the other hand, I don’t want to push, if you’d rather not discuss it, and will understand no problem if so.
I don’t mind talking about this. I had been eating 30 carbs daily for several years. During this time my BP was normal. My A1c was 4.6. Before the event my total cholesterol had risen to over 300. Both my HDL and LDL were quite high. My Trigs were very low. I had been a type 1 for 50 yrs. I wasn’t well controlled during the urine testing years. I was well controlled after that.
My grandfather died in his 60’s from a heart attack and my father had a slight heart attack in his late 60’s. I was 60 when I received 2 stents.
I feel that stress had something to do with my arteries closing but the cardiologists don’t give that any weight.
I had been working part time and taking care of my aging parents part time. During this time a good friend suddenly died, a week later I was with my father as he died. A week after that I had a kidney stone which had to be removed. During surgery bladder cancer was discovered. The cancerous tumor was tiny and was removed.
For the next 3 months I took care of my mother who slowly lost her mind and then died. A week later I was starting a hike with my family when suddenly I became very tired and my arms became very heavy. I googled heart attack and my husband took me to emergency. My EKG was abnormal, but I wasn’t having a heart attack.
I don’t have much info about my stents but probably do somewhere. I carry a picture which shows a blockage of 70% to 90% on the RCA and 80% on the PDA. The letters DES are used in notation.
I did not do much research about the placement of the stents because I was worn out and my husband was soon diagnosed with esophageal cancer and all my energy went into researching ways to help him.
Wow @Marilyn that’s a lot to go through. I’m so sorry that happened. Personally I think stress has a lot to do with everything concerning our health. But we can’t always escape it either.
After my dad died, he greatly reduced his fat intake. I remember him drinking black coffee and eating plain toast. He stopped eating desserts. Because of a leaky heart valve he had angioplasty at 83. The cardiologist and nurses couldn’t believe the condition of his arteries which were in great shape with almost no plaque.
I have no idea if his slight heart attack had anything to do with plaque, but he never needed stents. He died when he was 89 because of his leaky valve which is good, because he would have been lost without my mom.
You went through a lot. Your post is a cautionary tale for us all - but how do we do self-care in the middle of several emergencies?
I was curious because I find it’s unusual to hear of a blocked artery, with high LDL being the only sign/symptom, that’s why I was asking about how controlled your blood pressure had been at that time. Not that you had much time in between crises to step into a CVS or drug store to get your BP measured - but probably all the stress, lack of sleep, and emotion did increase your BP, and/or increase cortisol levels. I’m guessing you’ve never smoked. DES means that the stents contained a drug that contributes to the artery’s overall health and functioning.
I have home tested my BP for a long time. When low carbing my blood pressure tended to be normal to low.
No, I never smoked, never did drugs, never drank a lot. My diabetes kept me from trying most of what my generation at least tried a few times.
I assume that plaque builds up for other reasons than high blood pressure which I didn’t have. I did not have a heart attack. The only reasons I was given were high LDL levels and diabetes. The fact that I was very well controlled didn’t seem to make a difference. The only thing that stood out was high LDL. High HDL and very low triglycerides did nothing to protect me.
Some people can eat a very low carb diet and have normal LDL levels. Dr. Bernstein is an example of this. I couldn’t. My LDL levels rose a lot when low carbing. I continued low carbing for several years after needing stents. My body started objecting in other ways that I couldn’t ignore. I wish I would have stopped eating low carb much, much sooner.
I spent 11 yrs eating no more than 30 carbs a day, but for my body, it was a huge mistake. The only good thing it did for me was to make me aware that for me I need a quite low A1c. It has protected me from getting any other complications of diabetes over the past 20 yrs.
From my work experience, I have recently come across a patient whose BP is generally ok, however when she gets upset or stressed it soars. Do these “flash” episodes of elevated BP do arterial damage? There are a few supporting studies out there on coronary studies in children; and on soldiers during the Korean War (average age of study participants was 22), 45% of whom who had some evidence of atherosclerosis with 5% showing gross evidence of severe coronary atherosclerosis. So this process can start in the very young. All of this can present a prescribing conundrum. Thankfully I am not a prescriber. Speaking of, you say your BP is controlled and always has been – but are you taking Losartan?
Your case is for me a definite puzzler. For example, I’ve never really heard of LDL being the only risk factor for a blocked artery. Wouldn’t the cell wall need to have been damaged first, in order for plaque to collect there? That’s what I would think, at any rate. (Is it possible that being on keto or low carb, one would need to be even more particularly mindful of stress, and possibly of insulin as well?) But I have no real experience with this.
Speaking personally, I am appreciative of the new way we are looking at things – with processed food being the “real” culprit as opposed to the automatic demonization of fat. This has made me more aware and I aspire always to do better with the processed carbs, and reading all about it has in general helped me a lot as I tinker here and there with a few pounds lost and other markers. However, at the same time, I’m mindful of the humongous sex bias – too strong a word? - in this new way of thinking/clearing the air. The keto community is overwhelmingly male, or so it seems to me in my forays online. There’s a lot more to be learned regarding keto/low carb and females. (I am female.) Also, I have read that you think fat is indeed a problem. So – I “get” that.
As Peter Attia has said on the role of arterial inflammation, “There is no perfect way to answer the question, there’s no experiment we can design in humans. So you have to look to natural experiments. People with a super human immunity (rare genetic mutation) to atherosclerosis/heart disease have an unbelievable ability to clear LDL from the body. They’re taking more of the boats out of the river. Their LDL is between 5-40. Conversely, there’s familial hypercholesterolemia – which is a paucity of LDL clearance capacity. They are more susceptible to atherosclerotic disease.” It’s a “gradient driven process.”
What it lately is coming down to for me is: We know that what’s conventionally known is that dyslipidemia causes heart disease.
What’s not conventionally known or accepted and needs more research is the role of higher levels of insulin vis a vis the damage it can do to the endothelial lining, and the role of stress on vascular wall damage.
I was on the extremely low carb diet when I suddenly needed stents. While on that diet my BP was normal. Unfortunately after years on that diet, I started passing out when getting out of bed. We called an ambulance several times. My glucose level was good, my BP had fallen drastically.
I quit this woe because of passing out one too many times and because I was getting horrible migraines. Once I cut out dairy and then several months later started a low fat plant based diet, the headaches and periods of passing out stopped.
After more than 3 yrs on my present diet I recently passed out again, so no more hopping out of bed for me. On my present diet my BP rose and I now take 50 mgs of losartan and a supplement. For most people this woe lowers BP, but I am an exception. I did not take a med for BP until about 3 yrs ago. I recently lowered my dose from 100 down to 50 mgs, because my BP dropped much too low 89/43. I fainted during this period of time.
My other risk factor for stents was and is diabetes. All of the cardiologists have told me diabetes and high LDL. Cardiologists see many diabetics, but many of the diabetics are uncontrolled.
When low carbing my A1c was 4.6 and the highest level was 5.3 for 11 yrs. I normally took 17 to 23 units of insulin. I had no working beta cells. I weighed about 10lbs more than I do now.
My life has had long periods of times that were extremely stressful. Our son had severe Tourette’s Syndrome and early onset bipolar disorder. We didn’t send him to school because most professionals medical and others did not understand his behavior which was severe. I spent all my efforts, when possible, trying to find experts in these two illnesses. My husband and I were stressed and exhausted for more than a decade. Then I switched to taking care of my parents.
My husband has had cancer 4 times in the last 10 yrs. after I received stents. Stress has done a number on us, but the cardiologists ignore that factor.
Omg, I thought you were male. LOL What does that say about me??? That is hilarious on my part. So much for being a feminist!
You are right, men are the low carb advocates. One man wrote a book about the cholesterol myth during the time I was low carbing. He said that LDL could be ignored. He is very well educated and he quoted many cardiologists. Several of the cardiologists have said that he misquoted him. His book helped make me ignore my cholesterol numbers, I didn’t do more in-depth research about the book until a few yrs ago. From now on I am very careful about believing what I read. These doctors and researchers especially ones who are making money from books and YouTube videos can be very persuasive, and they can be wrong.
As a child I took 40 units of insulin after the age of around 30 the amount has been steadily coming down. I haven’t taken more than 30 units in many years.
I eat very, very few processed foods. I eat out very seldom and try to stick to my woe. I eat 250 to 275 healthy carbs a day, I exercise an hr a day. I normally use 23 total units of insulin daily. I have heart stents but no other complications of diabetes. I have had numerous problems but by keeping a very low A1c they have all reversed. The only neuropathy i have had was caused by a statin.
Both of my parents had normal LDL levels when they both died at 89. Neither took statins. I do remember that when my mother was about my age that her cholesterol levels were not good. I have no idea what enabled her to have a very decent LDL level in her later years. My sister who is 73 is in perfect health. No diabetes or hypothyroidism. She has a decent LDL number and definitely has no heart disease, her BP is good. I am the diabetic, and she is the extremely healthy one. She eats what she wants.
I can only go by my own experiences. This is what has happened to me.
Thanks so much for reading this.
@The_Senator_From_Glu I have what they call white coat syndrome. I have read in the past this puts you more at risk of strokes. Same with if you get migraines or flush easily. So some rise in BP for short periods of time puts you at risk for certain events. Now whether it’s a genetic factor that makes these things happen and it is also what puts you in the category of more at risk of stroke, or if it’s the fact you do and that puts you at risk I don’t remember if they have figured that out.
I’ve definitely heard of white coat hypertension, which is one reason some clinics give out automatic BP cuffs so patients can measure it in the comfort of their own homes. I haven’t delved deeply into its effects, though, so I can’t comment beyond referencing what I said above, meaning that likely it has effects. I’ve also heard others say it’s (white coat htn) truly not a thing, but I tend to believe that it probably is.
It definitely is a thing and much more recognized now. I used to have to explain and now they know what it is and I’ve even had a few nurses say they have it.
I always joke it is the test I will always fail as soon as I see the BP cuff coming! When I moved my new doctor of course didn’t actually know I had it, just what I said. She had me bring in my BP meter to check it’s accuracy then take a bunch of readings before I went in the next time. I don’t blame her at all as I would be in doctors sometimes with a 160 over 90 readings. So sure enough I brought it in showing a 117 over 77 average. but testing right at that moment 156 over 86…She documented the average and some of the readings.
I have a tendency for my levels to get better as I get used to the doctor.
I have kept daily records of my BP for several years. I will skip a day or two here and there. I always take the records with me when I see my GP. My doctors, both allopathic and naturopathic don’t mind when I adjust my BP meds since I keep good records.
My BP is almost always higher in the doctor’s office. The doctors and nurses recognize it as white coat syndrome. It will stay high if I am disagreeing with the doctor, and it will go down if we are getting along well.
When I was in the hospital with an undiagnosed problem, and lots of stress fighting to keep my insulin, my BP went through the roof.