Went off statins, now cholesterol is up. KCKO?

(betsy.rome) #1

I stopped my 40 mg. Pravastatin 3 mo. ago after reading about how it’s not worth taking for women my age (early 60’s) – went off statins, against my doc’s advice. Been T2D for 12 years; have gradually lost 35 lbs doing keto over 3 yrs, now within 15-20 lbs of goal weight.

Just had a lipid panel done, 2 weeks after vacation (I was keto but did cheat a little). They omitted my request for particle size, so I won’t know till I retest in 90 days whether they are fluffy or dense.

Am I doing myself a disservice going off the statin? Or should I trust my lipids will settle down once I lose the rest of the weight? My father had a triple bypass at age 65, I don’t want to follow in his footsteps. Numbers below:

Total chol = 312, up from 218
Good news: HDL is 111, up from 85
Bad news: LDL is 185, up from 123
Trig’s are 60, up from 50
Chol/HDL ratio is 2.6 - same.
Fasting BS 101, A1C 5.4
Fasting insulin 4.2, up from 2.0.

(KetoCowboy) #2

Just so I’m clear, your trigs are UP 10 points from a pre-keto lipid panel?

(You've tried everything else; why not try bacon?) #3

Are the triglyceride and HDL numbers flipped, by any chance? You are the first person who’s posted numbers on these forums where the trig level is about half the HDL—usually it’s the other way round. Anyway any triglyceride/HDL ratio that is less than 2.0 is great. If your numbers are correct, your trig/HDL ratio is 0.54, which is fantastic–and even the other way round it still would be 1.85, which is also fine. Ignore the LDL number until you get the particle sizes. Your HbA1C is very good, too.

(betsy.rome) #4

Trigs are up 10 points, confirmed, but I’ve been keto 16 months. Only change since last labs in July is going off Pravastatin, and taking the blood test 2 weeks after vacation. During this 3 months, my weight went down 3-4 lbs, then up again after vacation. I didn’t “carb-up” but had occasional other foods - a bun; potatoes, etc. maybe every other day.

(betsy.rome) #5

Confirming the trig’s & HDL numbers are correct, not flipped.
The only ratio listed on the lab was Chol/HDL ratio, which is 2.8.

The other red flag on my labs was carbon dioxide. Mine is 19, down from 26, normal range is 20-32 mmol/L. Now that is close enough to normal I’m not worried, but I was reading online that lowcarb / keto can cause low carbon dioxide. True? and is this good or bad?

I haven’t really been exercising, plan to add that in this next 3 months, walking, exercycle, swim.
What effect if any would exercise have on lipid levels?
Hoping to get some improvement on blood pressure from exercise, I still take 2 meds to keep that under control.

I’m fine to decline my doc’s recommendation to take the statin, as long as I’m not putting my heart at risk.

(KetoCowboy) #6

Thanks for clarifying.

Unfortunately, I’m out of my depth here. I didn’t (and won’t) stress about cholesterol numbers because I’ve seen too much compelling info on that subject from Ivor Cummins, Jeffrey Gerber, and a host of others. But I do pay attention to trigs, and if trigs had gone up on keto, I suspect I would be thinking about tweaks.

Good luck.

#7

My trig went from 69 to 115, and my HDL went from 85 to 81, after starting zero carb. I’m nit the last bit worried.

(betsy.rome) #8

Again, it’s not that keto made my trigs go up 10 pts, it’s going off the statin. Been keto for 16 mo.

#9

Your trigs are still under 100 which I have read is very good. The fact that HDL is over 100 is amazing. However I cannot and would not presume to give medical advice so this is something you will have to continue to research.

Were you still in ketosis after vacation?

I know I cannot eat buns or potatoes. Honestly the only time I am absolutely sure I am in ketosis is on an over 24 hour fast. The rest of the time the worst things I eat are natural peanut butter, limited berries and lower carb nuts and I still get knocked out

(VLC.MD) #10

Agree.

Agree / I’m not willing to try them !

FWIW, plain jane Vitamin B3 (niacin) lowers triglycerides. If the flushing doesn’t make you pass out. Omega 3s help too a bit ?

Fibrates, which include gemfibrozil (Lopid) and fenofibrate (Tricor), are an alternative to niacin. They reduce triglycerides by as much as 60% while raising HDL by up to 25%. The drawback: They may increase LDL levels

The omega-3 fats in fish and fish oil capsules are another triglyceride-lowering option. In studies, people taking three grams of fish oil daily have reduced their triglycerides by 30%.

(Todd Allen) #11

It’s possible your high HDL is too much of a good thing. Here’s a story on a study which suggests the optimal level for women is roughly 93 mg/dl and for men is 73 mg/dl.

https://www.sciencedaily.com/releases/2017/08/170823094124.htm

However, from quite a number of sources I’m doubting the significance of conventional cholesterol numbers as a predictor of cardiovascular disease. First, there are many flavors of both LDL and HDL and their various roles in contributing to or protecting from harm are incompletely understood. There are new tests that might better suggest your risk by examining the particle types and counts that make up your LDL and HDL. But other factors also come into play such as the amount of oxidation, glycation and various other degradations and contaminations of our lipids. Tests for markers of chronic inflammation such as C-reactive protein (CRP) are another option to evaluate risk.

When my doctor suggested statins for elevated cholesterol I declined on the basis that the list of side effects read like a description of all my existing health issues and I didn’t want to risk aggravating any of them. And we compromised by me taking vitamin B3 a common way of treating dyslipidemia prior to the marketing of statins. My latest lipid panel looked great though I expect changes in diet, exercise, sleep and stress management each played a bigger role. I’m glad I dodged the statin bullet especially having learned that even when they do significantly improve test numbers they statistically provide an incredibly modest reduction in cardiovascular events and often increase mortality which matters more to me than the cholesterol numbers

I found this book helpful for it’s discussion of factors relevant to cardiovascular disease and the many issues surrounding the focus on cholesterol.
https://www.amazon.com/Great-Cholesterol-Myth-Disease-Statin-Free/dp/1592335217

(You've tried everything else; why not try bacon?) #12

Well, then, you have a fantastic trig/HDL ratio. From what I’ve read the two markers that indicate risk for heart disease are a trig/HDL ratio above 2.0 and a high level of small, dense LDL. Given your excellent ratio, I would expect your small, dense LDL to be low and your large, fluffy LDL to be high. Dr. Phinney says that total cholesterol and the total/HDL ratio are useless as markers for heart disease risk.

Remember that it was Ancel Keys who came up with the idea that cholesterol has anything to do with heart disease in the first place, and the study he based it on has been shown to be biased, because he picked the seven countries that supported his notion, out of the twenty-two that he measured. If you include all twenty-two countries in the analysis, the correlation between cholesterol and heart disease that he claimed to have found disappears. As Dr. Phinney remarks, while it’s true that we see cholesterol where atherosclerosis is happening, but we also see firetrucks when buildings are on fire. Blaming cholesterol for atherosclerosis is like blaming firetrucks for fires.

Dr. Phinney also points out that about half of the people who have what is called “familial hyperdyslipidemia” (a genetic condition of very high serum cholesterol levels) live completely normal lives with no sign of heart disease, and they have completely normal lifespans. So it isn’t the cholesterol that is causing the heart disease in the other half.

(betsy.rome) #13

Amazingly, I was still in ketosis after vacation. I kept keto most the time with only occasional carbier treats. But I was also more active. Guessing ketosis is my “normal” that my body is used to & attempts to maintain, after over a year on keto.

(You've tried everything else; why not try bacon?) #14

Dr. Lustig says that the reason the body metabolizes glucose in preference to fatty acids is not that it “prefers” glucose, but simply that hyperglycosemia is a metabolic emergency that can be fatal if not dealt with immediately.

(VLC.MD) #15

Pretty cool stuff.

From the article.

0.4 per cent of the men and 0.3 per cent of the women covered by the study had an extremely high level of HDL in their blood, and a further 1.9 per cent of the men had a very high level.

The new study examines the statistical correlation between mortality and HDL levels. It therefore cannot explain why people with extremely high or low HDL levels have higher mortality.

The study also found excessive mortality for people with extremely low levels of HDL in the blood. The people with medium levels of HDL in the blood had the lowest mortality. For men, this level was 1.9 mmol/L. For women, it was 2.4 mmol/L.

2.4 mmol/L = 92 mg/dL
1.9 mmol/L = 73 mg/dL

betsy - yours is quite high 111 mg/dL = 2.87 mmol/L. Your HDL is higher than 999 out of 1000 women ?

I can’t say I’d be worried if I were you. I’ll suggest it isn’t the HDL that put those women at risk of CVD, but something else they share in common.

Dr. Yusuf (Cardiology) wisely said that everything in the human body has an optimal range. everything. There is too high Sodium, and too low sodium. There is too high Hemoglobin, and too low hemoglobin. HDL must be the same.

Avoid the things that increase HDL ?
Do some things that lower HDL ?
Probably not worth changing anything. IMO.

FWIW, Pravastatin is a milder statin. I might cycle back on if for 4 months and see what it does ? Maybe at a lower dose ? But I don’t think it matters. I might find out what I eat alot of that tends to raise HDL and take it easy on it. Ask for a hsCRP and see if your inflammation is high. Might help sway you.

In summary, KCKO.

(Todd Allen) #16

It might matter why the HDL is high. Like LDL, HDL transports cholesterol particles of a range of sizes/densities and the pattern of elevation may matter more than the total. Perhaps the pattern associated with an elevated HDL total when eating low carb is less dangerous than what might be attained in the relatively rare cases while eating a lot of refined sugars, starches and vegetable oils - that at least appears to be the case for LDL and the healthier pattern A for LDL is correlated to having low triglycerides and high HDL which often occurs after going keto.

But I don’t think it’s been carefully looked at for very high HDL and I wouldn’t rule out the possibility that very high HDL on a keto diet is just as bad or even worse.

After a year of keto and fasting my HDL went from 35 to 82 and my triglycerides dropped from 250 to 89 which I and my new doctor interpreted as signs of great improvement along with huge drops in ALT, CRP, HbA1c, cortisol, blood pressure, pulse and several other biomarkers of metabolic dysfunction. This study indicates my HDL might now be too high but considering my blood pressure is now typically 110/70 without medication and it was frequently 160/110 with medications when trying to eat a supposedly healthy nearly vegan and super low fat, low salt diet I’m still inclined to think I’m mostly getting it right now.

(VLC.MD) #17

I think that is a distinct possibility, maybe probability ! After all, the body and blood are a very interconnected soup.

Of course that same rationale can be used to justify anything.

One question I have is … what biomarkers are the highest priority for improving cardiovascular health while on keto ?
which are the least important ? Tough question to answer. Might be fun to think about it. But … at the end of the day, a high HDL is quite likely unimportant. It might be useful for betsy to “biohack” and purposely eat to lower her HDL. The only 2 good things I know to lower HDL besides statins are smoking and stop exercising :slight_smile: And I’m sure the last 2 wont appeal to betsy - heh.

If that was my HDL I’d be proud. I’m not sure I’ve finished first in a competition of 1000 people ever ! Haha.
She’s a virtual HDL gold medal olympian.

(VLC.MD) #18

ALT (fatty liver) CRP, HbA1c, cortisol, BP, pulse - absolutely every one of those HAS to be more important than HDL. I think that is an easy call. Especially BP, HbA1c, CRP.

Re: High HDL and Keto.
Looks like Medicine needs new 95% ranges for what is a typical HDL while in ketosis.

(You've tried everything else; why not try bacon?) #19

According to the studies Dr. Phinney cites in one of his lectures, the strongest associations are with small, dense LDL–the higher the level, the greater the risk of heart disease, for reasons he discusses in the lecture–and the ratio of triglycerides to HDL–the more HDL and fewer trigs, the lower the risk of heart disease. These are apparently very strong correlations. There appears to be almost no correlation between total cholesterol and heart disease, he says.

I understood Dr. Phinney to be saying that the role of HDL is to return unused cholesterol and fatty acids to the liver for reprocessing. The large, fluffy LDL delivers cholesterol and fatty acids from the liver to the cells. As its cargo gets used, it eventually ends up as intermediate-sized LDL and is scavanged and returned to the liver. If there is not enough cholesterol to make large, fluffy LDL, the LDL that gets made is smaller in size and eventually ends up as small, dense LDL, which is easily damaged by oxidation. When too badly damaged, these lipoproteins are no longer recognized by the scavanging mechanisms and cause problems.

(I should do a better job of bookmarking these videos. Then I could post the actual video instead of relying on my memory for a summary.)

(Todd Allen) #20

Maybe there are statins that lower HDL but I’m pretty sure that a modest raising of HDL is more typical, though I believe they are considered less effective than niacin or fibrates for the purpose of raising HDL. Statins are more effective at lowering LDL than niacin or fibrates and thus combination therapies are sometimes used if the goal is to both lower LDL and raise HDL.