High cholesterol

I am concerned and confused about why my lipid levels are the way they are. My doc says I have high cholesterol levels and I should take statins. Last weeks lipid test said that my LDL-CHOL is 129 mg/dL, HDL-CHOL 62 mg/dL, LDL-HDL Ratio 2.1, Cholesterol-HDL Ratio 3.3. It says cholesterol is high at 204 mg/dL.

I have been following Dr. B's plan for 4-5 months. I have been eating large amounts of fats (butter, heavy cream, olive oil, eggs, meat, cheese)and fiber (flax, almond flour); a good amount of protein, a good amount of vegetables, lot of liquid sucralose. Some things I wonder are: are my cholesterol levels high because of the way I have been eating? Should I consume less of certain types of fats, am I over doing it with the amounts? Am I having too much protein (11 oz per day for skinny 145 pound man)? Are they high because of elevated BG levels over the years? Is it just because I eat low carb now? Is it a thyroid issue? Should I try to see a dietician or diabetes educator?

..I feel frustrated and confused about what has happened, and what I can do to take preventative measures. I'm considering the meds, but I am hoping that the levels will level out over time, and that I can find a more natural way of dealing with this besides more drugs. I feel I am lacking in knowledge but want to continue learning.

I feel like that there is something related to the lifestyle switch to Dr. B's plan or my eating habits that might have affected my levels moreso than it being caused from other things (not that they haven't attributed) because of the timing. My previous cholesterol/lipid levels were at normal ranges before this one. It does not help that my doctor does not know about Dr. B's plan and hasn't ever worked with anyone who has been on it. He says there is no science behind it..

This lifestyle change has been fantastic for me btw. More energy, best blood sugar control ever. I really do not want to go back to high carb, I just want to improve the foundation it if I can.

I feel somewhat lost. If anyone has any advice, stories to share, etc. it would be much appreciated! Thanks for reading.

You don't mention you triglyceride levels...

Typically LDL is calculated using the Friedewald Formula (1972):
LDL = Total Cholesterol - HDL - TGL/5.0 (mg/dL)

(Reference: http://www.clinchem.org/content/18/6/499.abstract?ijkey=41a6344be3b... )

This formula does NOT hold up to high triglyceride levels (greater than 400 mg/dl)
I've read that it also does NOT hold up with low triglyceride levels (below 100 mg/dl)

There is an alternate formula know as the "Iranian" Formula (2008) that has been shown to be more accurate for those that have low triglyceride levels (as those low carbing often do):
LDL = TC/1.19 + TG/1.9 – HDL/1.1 – 38 (mg/dL)
( Reference: http://www.ncbi.nlm.nih.gov/pubmed/18426324 )

A Total Cholesterol of 204 isn't something that I personally would be so concerned with as to go on statins. Your HDL value is great, and I'm guessing your HDL/Triglyceride ratio is great too!

As drug therapy to reduce cholesterol became available the "normal" levels were dropped to 240 mg/dL or less and then to 220 mg/dL, and eventually 200 mg/dL...
Do some reading, and consider how much of this is financially motivated by interest lobby groups...

As an aside, I'm waiting to get my lab work back tomorrow....

It will be a year since I was diagnosed and started to reduce my carb intake.
I'm not to the level's of Dr. B's plan, closer to 80g/carbs day.

At the 6 month mark, I'd dropped a lot of weight and my LDL was elevated.
I've read that is typical during periods of weight loss.
Now that my weight is a bit more stable - it will be interesting to see where the numbers come in at.

As you asked about how much protein...
As a rough target, I go for .8g of protein per pound of lean body mass.
Some studies have shown that is as much as the body is able to use while you are trying to add muscle mass. (Less is required to simply maintain).

I'm 6' tall, about 152 lbs. Lean Body Mass ~128 lbs.
As a result I target a minimum of 100g of protein a day.
I don't limit myself, but have been tracking pretty closely lately...
I find myself anywhere from 105g - 200g on a given day.

When you say 11oz, is that just "protein" or is that the weight of something else (meat, cheese, egg, etc)?
If that is just protein... at ~30g/oz I'd call 330g of protein a day on the high side.

If that is meat (considering that an ounce of meat or fish has approximately 7-10 grams of protein...)
I'd say that is a reasonable level (77-110g of protein), depending on your goals.

How many calories do you target in a day?

I got my numbers back from my Doctor a bit ago.
Numbers are below, and all show improved from 6 months ago.
His take on my cholesterol was that there is nothing to be concerned about.
He took it off the list of things to check at my next 6 month follow-up.

(I'll note that my readings appear to be worse than the original poster's, though hard to confirm without Triglyceride info)

Total Cholesterol: 206 (down from 234)
HDL: 51 (Up from 45)
LDL: 140 (Down from 164)
Triglycerides: 73 (down from 126, and down from 317 a year ago)

Running my results through the two formulas:
Friedewald Formula 140.4
"Iranian" Formula 127.2

I'm good with the fact that he seems ok with the numbers.
If he was concerned - considering the improved Triglyceride levels,
I'd be asking for some particle size tests such as VAP or NMR.
My understanding is that those tests can directly measure LDL cholesterol (as opposed to calculating it), and they also will differentiate between:
- small dense LDL particles (Pattern B, high risk)
- Large fluffy, buoyant LDL particles (Pattern A, low risk)

My Ratio of Triglycerides to HDL-Cholesterol has greatly improved over the past year...
Dropping from 5.5:1 to now being under 1.5:1
It is my understanding that this is one of the best indicators of CVD risk:

As a side note, this is the "special topic" for Bernstein's teleconfrence this month. It can be found here on Wed. March 28,2012 at 7PM CST, 8PM EST and 5PM West Coast Time.:

Im quite curious about this as well as my chol. has gone up, tri, HDL & LDL. I'm in my mid 30s, so the idea of a statin puts me off to some extent.

Congrats on the dramatic improvements!

Thanks for the reminder.
I keep meaning to tune into one of those teleconferences and see what they are like.

I honestly think that different people have different metabolisms, and what works for one may not work for another. I also think that all the negative press about statins is hysterical and inaccurate. If you really want to know the pros and cons about statins, you need to read the scientific papers. They tend to be much more cautious than the screaming headlines in the public media. The fact is that very few people experience serious side-effects from statins, but you'd never know that from the widely circulating hysteria. That is not to say that you aren't taking a risk when you take statins, but the risk is very low. Even if someone says they had side effects, they aren't YOU.

Personally, I have been limiting carbs for more than a year now, and my lipid profile improved radically, but again, I'm not YOU. For me, there are clearcut downsides to eating carbs, and I have seen positive results from limiting them. But that may not be true for you. You might be one of the folks who does well on a diet that includes whole grains, and the only way to find out is to try it. For myself, I would give the low-carb approach a year, and if it still isn't working out, then try another approach. And if you need statins to achieve cholesterol goals, then try them. If you react badly, you can always stop. But there is LOTS of scientific literature out there that confirms that statins DO reduce the risk of early heart disease, and it is well-known that heart disease is what kills most diabetics.

Your body, your science experiment, but make rational decisions, not based on hysteria.

This lifestyle change has been fantastic for me btw. More energy, best blood sugar control ever. I really do not want to go back to high carb, I just want to improve the foundation it if I can.

Exactly how I feel. Diabetes has never been better, but dang, if there isn't another issue!

On a side note, anyone know the difference between an ace inhibitor and a statin?

Thanks for this info. I am curious about financial motivation too. Would there be a total cholesterol level that you would consider going on statins for? I will research this more, thanks.

What is the importance of trigliceride levels? I will look into this.

My triglycerides level is 66 mg/dL which is in the range it lists (00-149) so I suppose thats good! When would you say cholesterol is our enemy? Is not? I want to be an ally and friend with cholesterol ;)

When I say 11 oz I mean that I either weigh or estimate the weight in ounces of the food I eat (meat, cheese, fish) for 1 oz = 6g PRO or I look at the nutrition label's protein grams using 6g = 1 oz PRO (which is how I count eggs). So in my mind that means I eat about 66 grams of PRO a day. At least that's how I measure it and calculate that with insulin. So I guess maybe there is other things within the food that I eat that might not be pure protein. Is this an effective way to calculate accurately or am I missing something?

How have you calculated your lean body mass?

I do not pay attention to calories at all, but I strictly eat 30g of carbs a day.

awesome, great work and commitment, this is motivating!

The particle sizes is what I've been hearing matters most in terms of risk factors, its good to learn about. Thanks for the info. and your story!

Thanks for your advice. I connect to a lot what you said, our body is our experiment, and all bodies do not work the same and need different types of care for optimum health. I think one thing that can be challenging is trusting myself and my experience over what others tell me (esp. if they got a degree) I am and should do when I got a pretty good idea of what works and doesn't work for me. But we know ourselves best, I would say ;) thanks

cool! thanks for the info.

So far as protein - that's a reasonable means for estimating.
Sounds like your getting an appropriate amount for maintenance.

So far as calculating lean body mass -
I start by finding my body fat percentage.
Some of the easiest just need a tape measure, and there are tables or websites that will do the calculations for you.
(Some more accurate approaches use calipers.)

Depending on what I use to calculate it, I'm somewhere in the 12-16% range.

Scale Weight * (100% - Body Fat%)
For me: 152 lbs * 84% = 128 lbs

Knightshade, can you point to some reference material on the VAP and NMR testing? My Friedewald Formula LDL is at 137 ("Iranian" is 116.5) and the Dr.s are talking meds. I'd like to be able to know some additional testing options and how I can suggest them.

Also, thanks for the info about tri:HDL ratio and the article. I'm fortunate to have a 1.29:1 ratio currently. When my father went for his bypass surgery a number of years ago, his trigs where through the roof, but HDL was fine.

Some information about VAP can be found here:

Some information about NMR can be found here:

It was one of the topics covered by Dr. Mary Vernon in this podcast:

Fantastic, thanks!

Here is a great couple videos by Kris Kresser about Cholesterol and what numbers actually matter.
I Have High Cholesterol and I Don't Care.

In some of the research I have done, I have learned that normal blood sugar levels also decrease inflammation, and can cause cholesterol numbers to decrease. So, for me, as a diabetic, it's another reason to achieve as close to normal glucose as possible. I'm not interested in artificial/pharmaceutical fixes, though.

I posted on my blog about this recently.