Is CIMT necessary/useful if I've had CAC with score of 0?

(Kevin Haney) #1

After going to cardiologist to discuss high LDL (tested about 3 months after going keto). total went from 336 (was 226 prior to the diet), LDL 250 (prior 155). All other numbers and ratios great though (see below)

they tested

  • CAC - zero
  • did a stress test - no problems
  • wouldn’t do an NMR
  • recommended I reduce saturated fats and come back in a month and test again.

so I did reduce saturated, but not to the 10-15 grams per day they asked, but probably in the 30-50 range on average. I think mostly I cut out cheeses, and sometimes had chicken sausage instead of bacon some days, and introducing a few carbs (1/2 apple in morning with some almond butter or a few more blueberries in my 5% plain greek yogurt).
I should add that I am at my goal weight, and actually dropped a little while trying to reduce fat, so I don’t want to replace with carbs though… after restoring some bacon I went back to where I want to be.

image

so dropped down 100 points this time, pretty much back where I was before. HDL a little lower, but trigs lower and ratios still fine. I was frankly very happy with these results… but the nurse practitioner had a note with the test results:

The results of your recent blood work are available for you to view through MPM. There is significant improvement from prior, presumably due to dietary changes. Despite that, I still would like your cholesterol to be lower, but it is not an “arm twisting” recommendation for you to be on medication. If you get the Carotid IMT and it shows elevated risk, I would argue strongly in favor of adding a statin medication. Please don’t hesitate to contact me if you have any questions or concerns.

so my question is, should I get the CIMT? I still feel like regardless of the results of the CIMT, there still going to say “well, we still want you to lower your cholesterol”.

So I asked:

I suppose we can discuss at appointment next week, but I’m curious what the magic number is for statins. And what would be the basis for IMT considering my calcium score was zero, chol. ratios are good, and stress test was good? Is it purely because LDL is high there must be a problem? I’m not convinced LDL or saturated fats are a problem (insulin is), especially on a low carb diet.

reply was:

It’s an interesting question and there is no magic number. Rather, we try to put together a comprehensive approach to your long term, and, as such, yes, all of the things you mentioned (Coronary Calcium Score, Stress test, etc) are part of that and, in your case, very reassuring. Dr. xxxxx and I were discussing a patient of his who had a 0 Calcium Score, but evidence of significant atherosclerotic disease progression in his carotid arteries, which is why I would like to have the information from a Carotid IMT. However, this is nice to know, not need to know information and perhaps the most important piece of information is how you feel and what your preferences are. I look forward to discussing further.

So I have the followup appointment next week. Wondering if I should bother with the CIMT. I’m a computer nerd, so more data is always good I guess?

(You've tried everything else; why not try bacon?) #2

Tell your doctor to get caught up with the latest research. Your ratio of triglycerides to HDL is under 1.0, which is fantastic. Between that and your calcium score, you have a very low risk of heart disease. According to several recent studies, cholesterol appears to have a protective effect against heart disease, especially as we age. Some of the biggest studies designed to prove that lowering cholesterol reduced the risk of heart disease—the Minnesota Coronary Study, the Framingham Study, the Women’s Health Initiative, for example—actually ended up proving that lowering cholesterol not only failed to lower the risk of heart disease, it actually increased mortality from stroke, suicide, and other causes.

Several researchers also bring up the case of people with familial hypercholesterolemia, which is a condition of very high cholesterol levels thought to have a genetic cause. Yes, half of them die young from heart disease, but the other half never develop heart disease and die from other causes at a ripe old age. This strongly suggests that it cannot be the cholesterol causing the heart problems. As Dr. Phinney likes to say, blaming cholesterol for cardiovascular disease is like blaming fire trucks for fires.

Also, remember that you don’t have to take the statin, even if the doctor prescribes it. If you think your doctor is likely to be recalcitrant, check out www.cholesterolcode.com and see if you are one of Dave Feldman’s hyper-responders. If you are, you can manipulate your cholesterol numbers by eating the correct diet for several days before the test. For some support for not taking statins, here is a video by David Diamond, a neuroscientist who has some personal experience with the issue:

(Kevin Haney) #3

Believe me, I have no intention of taking a statin, and won’t be pressured to do so. I will “take it under advisement”! I’ve heard enough horror stories, even just from family members having trouble with statin side effects, not to mention the questionable benefit of using them.

I need to read up more on the studies. My problem is retention, I read them, but then can’t quite remember the facts enough to counter someone who makes a statement about high LDL being bad. Like the cardiologist’s nutritionist who mentioned Framingham - I knew it rang a bell and knew there wasn’t necessarily a “there” there, but didn’t know the facts to counter.

I’m familiar with Dave Feldman’s site (his arms must look like pincushions with all the blood draws!)
the 3 day thing is interesting. I would say I didn’t back off the diet before the March bloodwork (337 total) though probably wasn’t “keto” range (more like 30-50 carbs), so maybe next time I’ll try it and see what happens.

(You've tried everything else; why not try bacon?) #4

You might enjoy this second video by Diamond. It is an update of the topic, with some new studies examined.

(Rocky B) #5

Just watched this video. Thanks Paul. I’ve forwarded it to a couple friends on statins who need to be awakened.

#6

With a CAC of zero, I’d ignore the numbers for now and just really analyze what your eating, your fat sources, and try to figure out whats going on. If you REALLY wanted to make your doctor happy, show him the magic of the Feldman protocol and drop your numbers that way for your next test, when he’s very proud of you tell him what you did and you’ll never hear a peep about lowering fats again.

Yup, safe bet!

(Alec) #7

Oh boy, do I love nutritionists. Framingham has clearly shown there is no link between eating fat or saturated fat and all cause mortality. So the nutritionist doesn’t know what she’s talking about. She was probably told that by a statin salesman, probably with pretty graphs that were statistical lies.

The key here is to get them to show you the randomised controlled trials that prove the link between high cholesterol with an increase in all cause mortality. There isn’t any. I am sure there’s lots of epidimiological evidence, but as Nina and Zoe tell us all the time, association does not prove causation.

I recommend Nina’s book that totally debunks the science that links cholesterol and CHD.