Cholesterol numbers not what I expected...

[Tresses]

I hate to even post this, because it goes against everything I know to be true about LC eating, and against even my own previous experience on PP.

Two weeks ago, I had the usual blood work done plus some extras, triggered by the discovery of spots on my liver. The spots turned out to be 2 hemangiomas and are nothing to worry about (unless they cause pain or I experience trauma like a car accident).

Today, I got my results in the mail. I'm stunned...and not the good way. 7-8 years ago, when I first did PP, I actually received a 10% discount on a life insurance policy because all of my numbers were "perfect." (This, in spite of a history of high cholesterol.) OK, no surprise there. That's what we expect. (I no longer have those numbers.)

Almost 3 years ago, at age 39, I had the usual bloodwork done for a physical. I was in and out of LC eating, so I don't know how it affected things, but here are those numbers:

Total cholesterol: 246
HDL: 78
LDL: 157
Triglycerides: 53
Cholesterol Ratio: 3.2 (recommended range was under 4.4)

My doc then, was a little concerned that my total was over 200, and that my LDL was over 130, but because my HDL was well over 40 she wasn't ready to suggest statins...but she did mention the possibility for the future. I had no plans of ever starting statins.

Enter the recent bloodwork, at age 42, after 7.5 months of PP:

Total cholesterol: 331
HDL: 79
LDL: 241
Triglycerides: 53
Cholesterol Ratio: 4.2 (recommended range was < or = 5.0)

My HDL and Triglycerides are basically the same, but my LDL went through the roof. What the heck happened? :eek: Of course, my doc is highly recommending simvastatin. ABSOLUTELY NOT!

I know about the fluffy LDLs, and I've looked at PP and PPLP to review cholesterol chapters, but 331 total cholesterol is well over the range the Eades discuss as safe. And even though my ratio is within my lab's recommended range, it's higher than the Eades's. Unfortunately, I lent my copy of GCBC to a friend, so I can't look up Taubes right now.

Any ideas? I'm sitting here dumbfounded, trying not to be nervous. :o

[Mitra]

Here's a comment from somebody with similar numbers on Dr Mike's blog, with his response: I have been meaning to write to you for a while now, about my own cholesterol conundrum. I have been following a LC way of life for close to 2.5 years. My total cholesterol has gone up significantly, both LDL and HDL. Triglycerides have gone down. My ratios remain good, but I still worry, probably some deep seated remnants of fear from hearing the “experts” expound on the link between cholesterol and CHD.

I am a 43 year old woman, with no family history of CHD, or diabetes. The females from both my mother’s and father’s sides have prevalent obesity in later years (most were slim when young). I had put on an extra 40 pounds over a period of about 10-12 years. Since LC, I have dropped the 40 pounds and am a trim 120-122 lbs at 5ft. 3 inches.

Here are my numbers, for reference. The 3/04 numbers are from pre-LC and are very indicative of what they had been for the previous 15-20 years.

3/04 7/04 11/04 3/05 6/06
Total 215 273 294 276 352
LDL 125 173 192 163 240
HDL 71 69 73 92 100
TG 94 153 146 105 62
Total/HDL 3.0 4.0 4.0 3.0 3.5

I started taking flush-free niacin (500mg 2X/day), probably about a year ago. I had also been taking fish oil and flax oil capsules as well as a multivitamin like Centrum or One-A-Day. After reading your Protein Power and Protein Power Lifeplan books, I switched to taking a quality multivitamin/mineral/trace elements, and Carlson’s Cod Liver Oil, still continuing to take the niacin. I had started this regime maybe a month before my last cholesterol test. Then after reading about your experience with Krill Oil and curcumin, I have added these in the last month or so (after the latest test).

I have a biology background, and have read as many scientific articles as I can get my hands on to try and figure out if I should be worried. I believe in LC, and eating good fats, and do not believe that cholesterol is necessarily an indicator of CHD risk. I also know that higher cholesterol is protective and can contribute to longevity, particularly in women. But I don’t know if there is a limit to how much is good. One of your books says that cholesterol should be lower than 220, but shouldn’t go too low (I can’t remember what the low number is), based on scientific studies (U shaped mortality curve). This is where my concern comes in, since my cholesterol is significantly higher than 220.

I recognize that cholesterol is a necessary component in the body, and fulfills a vital role. The way that I understand the way LDL and HDL work in the body, it seems to me that it shouldn’t matter what the number is, as long as the ratio of HDL to LDL is balanced.

I refuse to go on statin drugs, which of course my doctor tries to get me to take. At the last appointment, I asked about the possibility of having a lipo-profile test done. The doctor didn’t know anything about it (although they are residents, so I excuse then to some extent), luckily I had brought copies of articles, and information about the test. The response was, we don’t do that test. I guess they weren’t even willing to check into having it done. The recommendation was for me to stop taking the fish oil, and have my cholesterol checked again in three months. Needless to say, I have not stopped taking the fish oil. I have tried eating less eggs and red meat, in case I have a problem with AA. But my consumption of dairy products has gone up as a result, which I am not sure is an improvement.

My question for you is should I be worried? And if I wanted to further pursue testing for my lipo-profile, and other risk factors (like crp testing, or an artery scan to look for plaques), who should I go to, a cardiologist, endocrinologist, or other type of doctor? I work at Duke University, and don’t know if Dr. Eric Westman see patients, but wonder if he might be interested in my case. I haven’t written to him, because I am not quite sure what to say, it seems like a bit of an imposition. This is also the reason I had not written to you before now, since I know that you do not give medical advice to non-patients. I am hoping that I have asked questions that you can answer though. Any other advice would be welcome as well. I admire you and your wife, along with the other professionals out there trying to spread the word of LC, and health.

Thanks so much.
Cathy

Hi Cathy–

Here is what the ‘real’ data say about cholesterol. There seems to be no relation to total cholesterol and mortality in women of all ages except for women over 50. In women over 50 there appears to be some protective effect with higher cholesterol levels. And if total cholesterol is high because it is made up of a lot of HDL, who cares?

As you know from reading this blog, I’m not a real believer in the lipid hypothesis of heart disease. Having said that, if there is any part of the whole hypothesis that I think is even part way valid it would be that HDL cholesterol is protective. And probably that small, dense LDL is more easily oxidized and may contribute to cardiovascular disease. It’s obvious that your HDL cholesterol is high, very high, in fact, so this should be protective.

You can go to the trouble and expense (it cost about $200 the last time I checked) to get your LDL analyzed as to particle size. There have been enough studies done now showing that triglycerides are a surrogate marker for LDL particle size–high triglycerides indicate small dense LDL; low triglycerides mean large fluffy, type A, LDL–that I don’t bother with the expensive test any longer. I simply look at triglycerides, and yours are certainly low. (You could request an ApoB test, which will show how many LDL particles you have; if there aren’t very many and you have a lot of LDL, then you’ll know that the particle size is large. ApoB is a less costly lab test than the direct measurement of particle size.) Even the folks who are firm believers in the LDL-cholesterol-is-bad theory, don’t particularly fear the large type A LDL particles.

I’m sure Eric Westman or Bill Yancey (they work together) would be interested in your case. I know them both. Tell them I suggested you contact them. They are both extremely nice and both are experienced with low-carb diets.

Good luck. Keep me posted.

MRE

[Tresses]

Mitra, thank you so much for that; it is very encouraging. The main difference between "Cathy" and me is that I do have a family history of heart disease (my mother had a heart attack at age 42) and diabetes (both parents and a brother, and my own Dx of "impaired glucose tolerance" 21 years ago).

I did have a stress test 4 years ago due to odd chest pains I was having and my mother's early heart attack. My heart was fine. I'm hoping it still is. :) (Then again, my mother is an alcoholic who smokes like a fiend...I really don't know what keeps that woman alive!)

I think I will look into ways of lowering my ratio a bit by raising my HDL through exercise, diet, and maybe supplements. I'll do that until my physical next year, and when it's time to order more bloodwork, I will also ask for that ApoB test that Dr. Mike mentioned, to give me a clue about the size of my LDL. If I end up at the doc before then and this comes up, I'll just ask for the ApoB test.

Breathing a little easier. Thanks again, Mitra. :)

[lczeledoc]

Tresses,

Don't worry about your Chol. numbers. They are just that, numbers, markers, not signs of disease. The most important thing is that your HDL is high and your Trigs are low. And I assume your FBG levels and HBA1c are normal. Those last two have far more bearing on your cardiovascular health than Cholesterol.

[Tresses]

Thank you, lczeledoc. I think the difference from my last test (when I wasn't seriously lc-ing) is what shocked me. That, and it's very different from my results 8 years ago after 3 months on PP.

My FBG was 77. :thumbsup: I asked for an HBA1c and my doctor said they don't order them unless the FBG is elevated. :suspicious:

[James L]

Hi Tresses,

FWIW, you may want to consider taking red yeast rice (RYR) as a supplement. Here are a couple of past threads that provide some additional information:

Pros and Cons of Taking Statins Preventively

Red Yeast Rice, an Alternative to Prescription Statins?

I am currently taking two 600 mg capsules of RYR daily and my cholesterol numbers are all good to excellent.

[Tresses]

Thank you for the links, James. I'll check them out. :)