What are yalls thoughts on the new guidance that LDL should be pushed lower and lower? I think my dad is saying his doc wants his around 60(?)

MRB10 said:

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I've been largely meat(mostly red meat) and fruit for over a year. 16:8 Intermittent fasting routine. 24 BMI. Single digit BF%.

Lipid panel from yesterday.

Total Cholesterol: 192
HDL: 53
Triglycerides: 61
LDL: 124

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I'm no lipid expert but that LDL is smidge high with an average HDL. Is it trending up or down or stable?

I'm on atovastatin 10mg @52 with 30 BMI (so not near as trim as you are!)
Total:213
HDL 84
LDL 118 (113 6 months ago)
TG 57

AgLiving06 said:

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What are yalls thoughts on the new guidance that LDL should be pushed lower and lower? I think my dad is saying his doc wants his around 60(?)

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I had this talk with my FP about a year ago. Apparently there is some evidence of plaque reversal if you can get below 70.

MRB10 said:

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I've been largely meat(mostly red meat) and fruit for over a year. 16:8 Intermittent fasting routine. 24 BMI. Single digit BF%.

Lipid panel from yesterday.

Total Cholesterol: 192
HDL: 53
Triglycerides: 61
LDL: 124

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Nothing wrong with those numbers. If a doctor tries to put you on statins with those numbers, I would certainly find a new doctor.

I am actually switching cardiologists and see my new doctor on Friday. The cardiologist I was seeing didn't even want to discuss diet with me. He told me because my small particle size LDL was elevated my problem was "100% genetic and diet won't matter for you". After reading "Deep Nutrition" and talking to a co-worker in a similar situation, I absolutely don't believe that.

I also am going to question why the other doctor put me on 10mg of Crestor/Rosuvastatin. I was having problems sleeping after I started it, so I am now pill-splitting down to 5mg. Another reason I am switching - I called my Dr. office to ask about the insomnia/dosage and they never called me back.

After a bunch of research, the Rosuvastatin dose sort of has a log-linear relationship to the LDL reduction. There are several NIH articles about this and Crestor even publishes this data on their website. It seems ridiculous to chemical load your body with the higher doses to get little to no gain in LDL reduction. Just appears the company wants to sell more product and increase revenue.

Here is an example NIH study:

Rosuvastatin for lowering lipids - PMC (scroll down to first green table).

2.5mg/day LDL lowered -39.1%
5mg/day LDL lowered -41.3%
10mg/day LDL lowered -45.6%
20mg/day LDL lowered -49.9%

Jbob04 said:

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MRB10 said:

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I've been largely meat(mostly red meat) and fruit for over a year. 16:8 Intermittent fasting routine. 24 BMI. Single digit BF%.

Lipid panel from yesterday.

Total Cholesterol: 192
HDL: 53
Triglycerides: 61
LDL: 124

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Nothing wrong with those numbers. If a doctor tries to put you on statins with those numbers, I would certainly find a new doctor.

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I would at least get a Calcium Heart Scan before a doctor puts you on statins. (not you, but a general you).

I have high LDL (genetic), doctor was like...Im thinking of prescribing statins I said, well, lets get a calcium heart scan here first before we do anything too drastic. Came back at Zero calcium.

Your general doctor is nothing more than an effing pharmacy. I'm not saying ignore their advice, but you need to be your own advocate instead of blindly going on medication you may or may not need.

Bonfire97 said:

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I am actually switching cardiologists and see my new doctor on Friday. The cardiologist I was seeing didn't even want to discuss diet with me. He told me because my small particle size LDL was elevated my problem was "100% genetic and diet won't matter for you". After reading "Deep Nutrition" and talking to a co-worker in a similar situation, I absolutely don't believe that.

I also am going to question why the other doctor put me on 10mg of Crestor/Rosuvastatin. I was having problems sleeping after I started it, so I am now pill-splitting down to 5mg. Another reason I am switching - I called my Dr. office to ask about the insomnia/dosage and they never called me back.

After a bunch of research, the Rosuvastatin dose sort of has a log-linear relationship to the LDL reduction. There are several NIH articles about this and Crestor even publishes this data on their website. It seems ridiculous to chemical load your body with the higher doses to get little to no gain in LDL reduction. Just appears the company wants to sell more product and increase revenue.

Here is an example NIH study:

Rosuvastatin for lowering lipids - PMC (scroll down to first green table).

2.5mg/day LDL lowered -39.1%
5mg/day LDL lowered -41.3%
10mg/day LDL lowered -45.6%
20mg/day LDL lowered -49.9%

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Yup...this...this nonsense is exactly what I'm talking about.

I had high cholesterol, probably 195-220. Started on Crestor about 20 years ago, up to 20 mg. Dropped the cholesterol to 130-135, with LDL around 60. Had 2 stents put in about a month ago. Just started on Repatha,, which should knock the cholesterol down another 50% with the goal of being clearly in the therapeutic range. Did a before cholesterol test and will follow up with a post Repatha test. Started reading Deep Nutrition based on this thread. Started adjusting to a new diet.

For the first time my lipid panel had a particle size test. Scored badly on that and read in Deep Nutrition that small particle size is a much stronger predictor than just LDL. Will be dicussing this with my cardiologist next week.

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Scored badly on that and read in Deep Nutrition that small particle size is a much stronger predictor than just LDL.

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Yeah, I found the information in this book very interesting. She says that the small LDL are created because of oxidative damage to the protein layer on them. They sort of lose their "information" on where they are supposed to go and end up in the vessel endothelia, creating inflammation.

FourAggies said:

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I had high cholesterol, probably 195-220. Started on Crestor about 20 years ago, up to 20 mg. Dropped the cholesterol to 130-135, with LDL around 60. Had 2 stents put in about a month ago. Just started on Repatha,, which should knock the cholesterol down another 50% with the goal of being clearly in the therapeutic range. Did a before cholesterol test and will follow up with a post Repatha test. Started reading Deep Nutrition based on this thread. Started adjusting to a new diet.

For the first time my lipid panel had a particle size test. Scored badly on that and read in Deep Nutrition that small particle size is a much stronger predictor than just LDL. Will be dicussing this with my cardiologist next week.

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Thanks for sharing and I hope you are doing well with your stents! Not that it pertains to my patient population but I think I'll check out deep nutrition as well as I know nothing about the particle size testing that is done on more advanced lipid panels.

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as I know nothing about the particle size testing that is done on more advanced lipid panels.

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Just FYI, the one my doctor runs is by Quest and is called "CardioIQ". Contains the small/dense LDL tests as well as some other supposedly important ones like Lp(a).

Just wanted to share an NIH article I found validating everything Shanahan wrote in "Deep Nutrition". All the while the American Heart Association touts vegetable oils as completely safe. Interesting how that works, isn't it?

https://pmc.ncbi.nlm.nih.gov/articles/PMC6196963/

Show us the money trail. I don't doubt you but I'd like to see this.

Explain to me how the AHA defends vegetable oils, which are made in basically refineries, as perfectly fine when the NIH is publishing studies confirming the exact opposite.

I can't explain. I'm just asking for the trail of money you referred to.

Jbob04 said:

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MRB10 said:

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I've been largely meat(mostly red meat) and fruit for over a year. 16:8 Intermittent fasting routine. 24 BMI. Single digit BF%.

Lipid panel from yesterday.

Total Cholesterol: 192
HDL: 53
Triglycerides: 61
LDL: 124

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Nothing wrong with those numbers. If a doctor tries to put you on statins with those numbers, I would certainly find a new doctor.

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My guy wasn't worried about it and said keep doing your healthy things like normal.

@kiddoc - it was 102 at the last physical which was 12 months ago. This is the first full year on this diet so I'll be establishing a base line over the next couple years.

I'm in my late 30s and my doc told me to wait until 40 to get the calcium scan. I fully intend to stay on this semi-carnivore + fruit diet until then and we will see what the results are. I feel fantastic eating this way.

Bonfire97 said:

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Just wanted to share an NIH article I found validating everything Shanahan wrote in "Deep Nutrition". All the while the American Heart Association touts vegetable oils as completely safe. Interesting how that works, isn't it?

https://pmc.ncbi.nlm.nih.gov/articles/PMC6196963/

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The fact that you believe the links you are posting are NIH articles/studies, or even the NIH agreeing with the data/conclusions in the paper shows a lack of understanding of how research works and how the medical field shapes their opinions/recommendations based off of research.

While it's great that you care about your health and are trying to live a healthy life, I'd caution you re: the Dunning-Kruger effect here.

thanks for sharing OP

Thank you for your clarification and I do admit that I misunderstood the source. However, I don't think that you basically calling me ignorant was warranted. If you don't have anything to add in regards to the health conversation on this thread, feel free to leave.

MRB10 said:

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I've been largely meat(mostly red meat) and fruit for over a year. 16:8 Intermittent fasting routine. 24 BMI. Single digit BF%.

Lipid panel from yesterday.

Total Cholesterol: 192
HDL: 53
Triglycerides: 61
LDL: 124

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since we're reporting. Just had my cholesterol tested last week:

Total:124
HDL: 49
Triglycerides: 47
LDL: 68

trying to eat lower fat, and exercise 4-5 days a week. 20 mg Atorvastatin

strangely my LDL went up and my Triglycerides went way down from four months ago when they upped my Statin from 10 to 20 mg.

In July I was:

Total :129
HDL: 58
Tri: 73
LDL:56

Any side effects with atorvastatin? I'm on pravastatin and my numbers are nowhere close to as good as yours.

They put me on avorastatin but it did not help lower my tri's. I think it did screw up my liver function test. So the bright idea was that since I'm borderline pre diabetic it was effecting how the statin performed. Now I'm on metformin as well, against what I wanted to do. So now u go back in a couple weeks to check the cholesterol triglycerides and liver.

None really. Maybe some leg cramps.

My cholesterol has really never been super high in my life - 140 was the highest. But I had a terrible calcium score about five years ago. So they put me on the statin.

No way I would take a statin with those numbers

I have a calcium score of over 2000. They are trying to limit anymore plaque - that is the reason I've been told to take the statin. I also "failed" my stress test in July. But my angioplasty procedure showed no serious blockage in any of my major heart arteries. It's all a bit of a mystery.

I have zero shortness of breath, can easily get my heart rate up to 140 doing cardio with no chest pain at all.

My Thyroid was enlarged and I'm hyperthyroid, so wondering if that has something to do with the stress test result..

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But my angioplasty procedure showed no serious blockage in any of my major heart arteries. It's all a bit of a mystery.

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My new cardiologist also told me I need the catheter/angiogram procedure because of my 1005 calcium CT score, so I have asked them to schedule it. Not really looking forward to this, though.

it's nothing really. You watch it all on the screen fully awake. The only recovery is a few days If they enter thru your femoral artery. some use the wrist and it's easier on the patient, but I'm told the cardiologist prefers the femoral artery.

KidDoc said:

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AgLiving06 said:

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What are yalls thoughts on the new guidance that LDL should be pushed lower and lower? I think my dad is saying his doc wants his around 60(?)

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I had this talk with my FP about a year ago. Apparently there is some evidence of plaque reversal if you can get below 70.

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My doc brought up the plaque reversal as well.

My latest labs came back with 213 total cholesterol, 89 HDL, and 112 LDL. Triglycerides are 62. The doctor basically just told me to lower my saturated fat intake and exercise. Based on what I've read, it seems like there is a good chance that my LDL is the larger, better kind? I do exercise almost daily and I eat fairly healthfully (although I do eat a decent amount of saturated fat from butter, meat, whole milk yogurt and cheese, and dark chocolate). I don't know if I should cut back or not. I have also heard that high HDL isn't good either and mine is borderline high.

AggieSarah01 said:

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My latest labs came back with 213 total cholesterol, 89 HDL, and 112 LDL. Triglycerides are 62. The doctor basically just told me to lower my saturated fat intake and exercise. Based on what I've read, it seems like there is a good chance that my LDL is the larger, better kind? I do exercise almost daily and I eat fairly healthfully (although I do eat a decent amount of saturated fat from butter, meat, whole milk yogurt and cheese, and dark chocolate). I don't know if I should cut back or not. I have also heard that high HDL isn't good either and mine is borderline high.

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Your HDL is excellent. Over 60 is good. I recently stopped my statin due to muscle recovery concerns and there is some animal data that it may contribute to dementia over time. I just finished a listen to Deep Nutrition and it is a pretty interesting and enlightening book especially for the lipid cycle. Her guidance with basic cholesterol panels is if your LDL is less than 3x your HDL you are likely fine. From your basic panel there is no way to know if your LDL is good or bad LDL as that involves a more detailed test that insurance doesn't cover.

Per that Doc though if your LDL < 3x HDL you likely have the healthy LDL's not the confused and broken down LDLs that lead to plaque formation.

Note this is NOT my area of expertise but I've been reading and looking into it for my own personal health journey lately.

https://drcate.com/

https://drcate.com/cholesterol-pills-statins-are-bad-for-your-brain/

ETA: most of my pre-diabetic morbidly obese teen patients have HDL in the 20-30s with LDL 130+. That is the kind of panel that indicates a lipid cycle dysfunction due to excessive sugar and seed oils per Dr Cate. I think it sounds pretty logical and reasonable and is a good explanation for the population health trends over the last 60 years.

Your doctor is stuck in the old days with his saturated fat take. He probably still believes in the food pyramid. Your numbers are great and your diet looks good. I wouldn't change a thing.

I had a CT score (calcium test) score of 0. I eat high fat/protein low carb and have for the last twenty years.

Responding to a couple of y'all at once.

Tex117 said:

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I would at least get a Calcium Heart Scan before a doctor puts you on statins. (not you, but a general you).

I have high LDL (genetic), doctor was like...Im thinking of prescribing statins I said, well, lets get a calcium heart scan here first before we do anything too drastic. Came back at Zero calcium.

Your general doctor is nothing more than an effing pharmacy. I'm not saying ignore their advice, but you need to be your own advocate instead of blindly going on medication you may or may not need.

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No. Remember that a CCT is a dry CT looking for plaque that has calcified. It doens't show non-calcified plaques or potential flow limiting lesions developing. Nor does it show any abnormal anatomy or issues that could put you at increased risk for developing an issue.

I would prefer people not be on statins, but the data is pretty clear that the lower your LDL, the lower risk of developing atherosclerosis.

MAROON said:

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I have a calcium score of over 2000. They are trying to limit anymore plaque - that is the reason I've been told to take the statin. I also "failed" my stress test in July. But my angioplasty procedure showed no serious blockage in any of my major heart arteries. It's all a bit of a mystery.

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What kind of stress test did you do? Nuclear? Echo? Or just EKG?

You can have transient coronary vasospasm. I think other things can cause tranient abnormalities in heart motion. But yes, I think with a CCT score of 2000, a high intensity statin therapy sounds appropriate. You said your lipids weren't bad. Have you ever had your lp(a) checked? Or do you have a family history of heart disease?

I think some people that get cramps on atorvastatin do better with resuvostatin. Something to do with water vs lipid solubility.

AggieSarah01 said:

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My latest labs came back with 213 total cholesterol, 89 HDL, and 112 LDL. Triglycerides are 62. The doctor basically just told me to lower my saturated fat intake and exercise. Based on what I've read, it seems like there is a good chance that my LDL is the larger, better kind? I do exercise almost daily and I eat fairly healthfully (although I do eat a decent amount of saturated fat from butter, meat, whole milk yogurt and cheese, and dark chocolate). I don't know if I should cut back or not. I have also heard that high HDL isn't good either and mine is borderline high.

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Your numbers are pretty good. Although, would be better if that LDL was a little lower. I know there is evidence that HDL is protective against high LDL. But you know what's even better? High HDL and even lower LDL.

Get an ApoB test if your're willing to change habits based on results of that. Remember that LDL is usually calculated on most lipid panels and not actually measured. You can get your LDL measured, or you can get an ApoB test which is cheaper and easier. ApoB will let you know the number of cholesterol particles in your blood, as apposed to estimated quantity of cholesterol in LDL floating around.

I eat a lot of what you eat (eggs, meat, whole dairy, dark chocolate). But I also incorporate some fish oil, olive oil, and fat from healthy plant sources (flax, avocado, nuts) when I can. I think if you can reduce your saturated fat intake for some of these healthier fat options, it should improve your lipid panel.

RightWingConspirator said:

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I had a CT score (calcium test) score of 0. I eat high fat/protein low carb and have for the last twenty years.

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Just in case you weren't aware, the coronary calcium score basically just tells you whether you should be on a statin or not. Can't draw any conclusions about the true health of your coronaries or their flow, other than that there may or may not be a certain amount of calcium, and how it compares to others in your age group.