Cholesterol Report Tool

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.

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@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.

Latest update now that another 3 months have gone by and I have updated lab reports that are in line with my weekly cholesterol home testing results which I will be happy to share if interested. I continue to be able to keep my LDL-C low and have improved many indices on my LDL-P results that did not look so good in my February Lab Reports. In Fixing some of this, it appears that my protein levels dropped a little below standard and they should be easy to fix. I was supposed to go for a CAC CT Scan a little over 1 week ago but the hospital postponed claiming it is not yet safe enough for those procedures. That has been rescheduled for June 2. On June 4th I will have my telehealth appointment with endocrinologist and ask her to cut my atorvastatin dose from 40 mg to 20 mg per day. I want to totally ditch the statin but still too early as it does reduce inflammation and want to wait until I have my CAC score to determine my next enhancement. Rather than go into a lengthy discussion of how I tweaked all my various Cholesterol numbers, I have posted the report here and will answer any questions. Overall, the key to the LDL-C reduction was a massive increase in Vitamin C.

Order 135889 - Results By Category - Cumulative - Ulta Lab Tests - Redacted.pdf (81.0 KB)

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Very good! I am impressed with the reduction of your LDL particle number. I have been researching lately and learned that the VLDL size and the LDL particle number are the most important numbers to keep track of. I don’t see a VLDL size here, but I may be overlooking it.

I won’t be getting any labs drawn for quite some time because I am isolating myself from everybody but my husband. I am working hard trying to get my particle number down and my VLDL size down. I took your advice and I am taking more Vit C. I am up to 3,500. Do you take more than that? I also lost about 5 lbs and am aiming to lose two more lbs. VLDL size is lowered by weight loss, lowering triglycerides, and exercise. My triglycerides are 49 and I already ride my exercise bike 7-10 miles a day. I have no idea why my VLDL is so high. Maybe because I already have stents and because I have had type 1 since I was a child.

Again congratulations on your lab improvements. Oh, great A1c too.

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Chol1.docx (303.8 KB)

I have uploaded this chart so we don’t get too quickly technically into the weeds. The Apolipoprotein B100 VLDL which comes from the liver is what we are all trying to forever manage better because that is the one that most of the time causes issues with atherosclerosis and other heart related problems. The Apolipoprotein B48 is generally not measured as those Chylomicrons travel through the body within hours and rarely cause havoc. The B100 starts as VLDL and as it delivers triglycerides and other goodies to the muscles and other organs it shrinks into an ILDL and continues on its journey and finally gets to be an LDL and that is where nasty stuff tends to happen. In a perfect body, the HDL scrubs it out and returns some portion to the liver.

It is at the LDL size that we are really concerned. If the peak size LDL is bigger than 222.9 angstrom, we are in good shape. Although mine has increased from 206.8 to 218.8, I am not quite there yet. This improvement, I believe is due to a higher intake of avocado (1/2 per day). The problem with a below standard peak size is that those small particles stay in the blood and they keep looking for yummy glucose to oxidize them which then gives them the opportunity to bust through the endothelial cell and cause plaque. (this is the 25 cent tour as it is a little more complex than that). This is where I realized that my A1C was really no where near as important as my Standard Deviation. When blood sugar flat lines, these poor small LDL’s have no glucose to grab onto and create havoc in the arteries. As I seriously clamped down on my standard deviation, my A1C dropped which was just a bonus. I think we are all talking about the same numbers, just in slightly different terms.

My lower particle numbers, again I believe is due to a combination of staying away from all trans fats, virtually all saturated fats, and an increase in Vitamin C. The Vitamin C had the biggest impact on LDL-C, but the really bad stuff we need to follow and control is our LDL-P particles.

For my February blood tests, I was taking 6000 mg per day of Vitamin C which seemed pretty scary but highly touted as no problem by top physicians around the world. For my may tests I had increased to 10,000 mg per day and saw a small incremental improvement but not sure it is really necessary. Vitamin C should be based on weight and for it to really have impact my understanding is that we need to take between 5000-10000 mg per day. They are pretty cheap bought in bulk at Amazon. So I eat 1 meal a day + a snack like a hard boiled egg for dinner. I take 3000 mg Vitamin C when I get up, 4000 with lunch and 3000 at bed time.

I get all my blood drawn at Quest Diagnostics as they are very friendly, professional and they are results I can trust. Their offices nationally normally open at 8 AM and they take appointments starting at 8:15. I book an 8:15 appointment but get there just before 8 so I can get in while the place is spotless and nobody else is yet around as the second appointment is normally at 8:30 and I am out of there by 8:20. They also give me my own exam room so that I can concurrent test with my equipment to make sure my weekly home tests are valid. It is safe and works perfectly.

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All oh so interesting. My LDL Size last time I checked in March of 19 was 216. I have decided to try to flat line more or at least not rise as much after meals by riding my exercise at least 15 min after all meals. I already ride an hr after breakfast. I have no desire to cut down on meals as they are a very enjoyable part of the day for my husband and me. I don’t fast either except for 12 or 13 hrs between dinner and breakfast.
Of course, I will try something different if I can’t bring down my VLDL or particle size with what I am doing now. I will see how much more Vit C my body will tolerate.

My numbers were quite a bit better when I was taking a very small dose of a statin, but it also gave me neuropathy so I will never try another statin. Repatha really messed with my hip, so I am no longer taking that.

I live in a small college town with only a hospital to use for lab tests.

I assume you prebolus? Micromanaging prebolus for different meals gets you 90%+ of the way to after meal flatline. After meal mild rise is not bad, but spikes produce delicious glucose ready to oxidize the small LDL particles floating around the blood. I also live in a small town of 1200 people but 16 miles South is Amherst, MA with 5 colleges and in that area there are a few labs. Google Quest Diagnostic Near me and you may be surprised that there is a place that will draw your blood near your location. They then send your blood to California or other labs around the country to process. My lab is 35 miles from me but worth the trip. Quest draws blood for many different companies. I order my tests through Ulta Labs online as they are much less expensive than Lab Corps and many of the others.

@CJ114 you might find Ascorbyl Palmitate form of Vitamin C interesting. Usually it’s not the sole form you take, but it’s a fat soluble form. Both forms of vitamin c (water and fat) may have slightly different benefits.

“Ascorbyl palmitate is a fat-soluble form of ascorbic acid that exerts the antioxidant activity characteristic of vitamin C on lipids throughout the body. In vitro studies have shown that ascorbyl palmitate may be more effective as an antioxidant in protecting lipids from peroxidation than water-soluble vitamin C.*

Just a note, in some people over 2,000mg of vitamin c can cause diarrhea. There is buffered forms like Ester C (calcium ascorbate) that usually doesn’t cause as much of an issue. Always drink a lot of water

I was told from several sources, some taking an insane amount of Vitamin C that you keep adding an extra 1,000 mg per day and at some point you start having diarrhea. Once you have diarrhea, you know your limit and from there back off 1,000 mg per day. I have not got to the diarrhea point yet but don’t plan to take more than I am taking now. I have heard of a few other forms of Vitamin C than what I am taking but they always seem to be in a powder form. That does not interest me, but always willing to try a different pill to compare over a few month period.

I am usually 65-80 before a meal, so I give my shot and eat very soon after. I live in Idaho, and have to travel 90 miles to get to a lab other than the two small hospitals near by.

Linus Pauling did a lot of research on high doses of vitamin c. There are a lot of natural help books that talk about taking high doses for various reasons. Balch is one that talks about your method of keep upping it until diarrhea and then back off.

Ascorbyl Palmitate is the only fat soluble form I believe and because of that can help the liver better. It comes in pill form from a few companies, but not as easy to find. It’s not as popular and is more expensive. The one I can think of first is Source Naturals.

Continuing the discussion from Cholesterol Report Tool:

Bummer - I worked for a hospital in Pocatello in the 70’s, flying missions out of a tiny airport and remember how remote everything seemed back then. With 65-80 pre-meal BG you should be able to pre-bolus the right amount at the right time to flatline. It is, of course, a trial and error game but one very worthwhile to conquer to limit LDL oxidation.

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I like you took some high doses for a while, you just get tired sometimes of taking so much. I reverted to using a couple of Ener C or Emergen c packets as a tasty form. Emergen C used to have a lemon lime unsweetened variety I used to love.

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Thank you - I will check it out and add to my list for perhaps 6 months down the road. I don’t like changing anything midstream of an experiment otherwise it becomes impossible to determine cause and effect but at some point will want to try to keep tweaking what I am doing. Thank you so much and all the others on this board as well that have contributed very helpful suggestions that I have been able to test in the real world and improve both my diabetic and cholesterol numbers. I am truly grateful to all of you for sharing your time and thoughts.

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