I have supposed (I make a hmmm noise in my head when I’m told things are hereditary) hereditary high cholesterol. I’ve been keto for quite some time but my cholesterol still remains high. I’m not sure how high, I need to ring the doctor and ask. I was having heart attack symptoms and went to the emergency department and was given plenty of checks. Heart seems fine but cholesterol high. They wanted to put me on statins. I said no. I know for most people, it’s dietary high cholesterol and keto fixes that. But what about those of us with the type that runs in families and keto isn’t working? My mum has had a heart attack, has heart disease and a murmur. My aunt and uncle died from heart attacks. Same side of the family. I know cholesterol isn’t bad like they make out but if plaque IS building up in the arteries and my family members are dying, why? Also how do I act now to stay healthy before I get older?
What causes 'hereditary' high cholesterol and heart attacks? Can keto help?
What numbers? LDL, HDL, triglycerides?
My first thought is Keto or Carni is the best diet for everyone!
LDL they moan about but hereditary high cholesterol doesn’t have much to do with diet. I’ve been keto for years.
Familial hypercholesterolaemia is indeed a genetic condition. However, it is not a problem in and of itself. Studies have shown that fully half of patients with FH live just as long as the general population (or perhaps a bit longer) and die of causes unrelated to cardiovascular disease.
There is, apparently, a gene that tends to come along with FH in the other half of the FH population, one that causes the formation of versions of fibrinogen and clotting factor VIII that make our blood clot more readily. These are the people with FH who are at much greater risk of cardiovascular disease, as you can imagine. The conclusion scientists in the 1960’s drew from this is that it’s not the high LDL that causes cardiovascular disease, but rather the greater coagulability of the blood.
In this sense, diet can indeed help. Keto may not lower your LDL, but it will minimise the likelihood of blood clots, first by minimising the glycation of our haemoglobin (glycated red blood corpuscles are far more likely to stick one another), and second by keeping insulin generally low, so that it is not interfering with the regulation of blood pressure.
Given that cardiovascular disease was a minor problem until we changed our diet to mostly carbohydrate instead of fat and protein, I suspect that the greater coagulability seen in some FH patients does not cause problems if the diet isn’t causing hyperglycaemia and hyperinsulinaemia.
Manda
I also have familial hypercholesterolemia. 18 months ago, my total cholesterol was 550 or so, and LDL was 450. It has been high to very high to mega high all my life. I am 60. 18 months ago I had a CT scan done, and my score was 10, which is not zero, but it is still very low (the scale goes up to 1400 or more), and the words they used was that I was at “very low risk” of a CVD event in the next 10 years.
So, my conclusion from that is that (for me) a lifetime of sky-high LDL has not caused CVD. I am not on a statin: I have refused statins multiple times during my life as my considerable cholesterol research had led me to understand that high LDL is not causal in CVD. What is causal is high blood sugar, which is why one of the key issues of being a diabetic is a very high risk of CVD.
Therefore, for anyone concerned about CVD, a very low carb diet is a good idea. I have personally chosen carnivore: not to avoid CVD, but to lose weight and reduce my considerable bodyfat that I have carried throughout my life. But the CVD risk benefit is there as well.
My strong recommendation to you in your situation is to go and have a CAC or CT scan done. These scans measure the actual disease progression. If you get a zero score, it doesn’t guarantee avoidance of CVD event, but the stats say that they become very very unlikely. If you do have some arterial calcification or soft plaque, then you will know that you really do have the disease, at what level, and then start taking steps to manage that.
Taking statins to reduce cholesterol levels in an attempt to prevent CVD is just mind-bogglingly bad medicine IMHO. Our bodies are built on cholesterol: every cell has cholesterol in it, and it is so important the body has a chemical factory (the liver) churning it out all day every day to keep us healthy. I am absolutely unconvinced that the medical authorities know better than my body about how much cholesterol or lipoproteins it needs. I reckon my body knows exactly how much it needs.
But…. If you have CVD symptoms, and/or you have a family history of CVD, I strongly recommend you get a scan to see if you do have arterial plaque. Best of luck. Please let me know if you have any questions.
You reminded me, Alec, that one of the possible side effects of taking a statin is increased arterial calcification.
But while arterial calcification is a bad thing and warrants taking a statin, the calcification caused by statins is good thing. I find that argument incomprehensible.
One way they justify this is by saying that the statins – I can’t remember the exact term, so I’m using a different one – “solidify” the calcification. I think the theory is that the calcification is less likely to break off and cause an issue that way.
But I agree with you that it doesn’t make sense to me that increased calcification due to statins is a good thing.
@PaulL @ctviggen That is also my understanding: the argument is that solid calcified deposits are less dangerous than the softer clots that have yet to solidify. TBH, I can see that being a decent argument, but I am not sure.
One of the things that I learnt when I asked for a CAC scan 18 months ago was that the CT scan measures both calcified and non-calcified plaque in the arteries, whereas the CAC scan only measures the calcified. So my doctor prescribed the CT scan in preference to the CAC scan, which seemed reasonable to me.
Bottom line, both the calcified and non-calcified deposits are a problem, and if it is true that the non-calcified deposits are more likely to break away, travel up the artery and cause a major blockage upstream, then doing something to calcify the newer deposits might help in avoiding CVD events.
So, although I don’t know, I am not quite so incredulous about their claims of statins calcifying and helping. Of course, the FAR more important thing that the doctors should be doing is explaining how to avoid the damage in the first place, which they don’t. They just say, here, take these drugs and all will be well. Which is just bollox.
Many people, including people I respect in the cholesterol world say that, but based on real life I disagree. It does seem for some it makes very little difference, for me it’s huge.
When I was doing standard keto my total cholesterol was usually in the 190-210 range, which I was fine with, my HDL was always good, my LDL was usually a little high vs “normal”, when I started playing with Targeted and Cyclical keto, which I still do a hybrid of now, my total cholesterol the last 2yrs or so it usually in the 120-150 range, so almost half!
My wife who’s numbers aren’t as drastically different as mine, had a huge drop in hers as well when she switched, her’s averaged in the 180s’-190’s doing standard keto and she’s usually around 140 now.
We both had a handful of other improvements as well, can’t be afraid to mess around with things to find whats right for you.
Yes, that’s true. The CT scan is better. I’m surprised your doctor prescribed it though. If I could get it prescribed, I’d take it instead. Were your results from the CT scan what you already said your results were?
It’s also not the cholesterol level itself that will definitely matter. In the end, it’s whether anything is going to block blood vessels or not.
I had an uncle (by marriage) whose family had a very strong genetic tendency to accumulate plaque in arteries. He was one of six children, and four died before they got out of their teenage years - this was an extreme and unusual deal. My uncle lived to 48, heart attack.
When I say prescribed what I mean is that the doctor provided me with the scan prescription which I took to the scanning place and they did the scan… I had to pay for it, as it is not covered by Australian Medicare. I think it was about A$300ish. I don’t think they do these scans without a doctor’s prescription. I think they involve some level of radiation, so you can’t have these regularly. [However, if I had a high score, I would be saying “bugger the radiation, my much higher risk is a CV event, I need to know regularly how this is progressing… ie have my actions helped or hindered the disease progression?]
Yes, my results from the CT scan were a score of “10”, which on the report was described as “very low” and I had a “very low” risk of a CV event in the next 10 years. I asked my doctor (clueless idiot) what the scale was (ie was this 10/100 or 10% or 10 on a scale up to a higher number…). He said he thought it was a scale to 100, which concerned me greatly, as 10% is not a number I would describe as good.
So I phoned the lab that did the scan report and talked to a person there who does the reports, and he clarified that this was a similar scale to the CAC scan scale ie it’s kinda open ended, but he said it often goes to 1400 and higher. He said if someone has a 1400 result they are at “end stage CVD”, whatever that might mean… I think he meant he thought the patient was at high risk of a CV event. He said my score of 10 was very low and he would not be concerned with a score of 10. He was, of course, full of qualifying language (which they have to be to cover themselves), but in essence, this is what he said.
If that is so, an Agatston (CAC) score under 100 means statin therapy is contra-indicated, so that is likely true for a CT score.
I think this is partially why my (idiot) doctor backed off from the “with your cholesterol level, you have to take these PSK9 inhibitors”. I had said no thank you to either statins or the PSK9 things before the scan result came through. When he talked me through the scan result (which is when I asked him about the scale), he seemed happier that I was at low risk, even with my sky high cholesterol.
I asked him: so if I have had sky high LDL all my life, why is my CT scan score so low? His answer: you’ve been lucky. He told me to drink plant sterol milk and eat plant sterol margarine to try to reduce my cholesterol. Absolutely clueless… that stuff is poison! And he was obviously unaware of the data that shows (especially if you are over 60, which I am), the lower your cholesterol, the higher your all cause mortality. I was tempted to ask why he was trying to kill me, but I thought that was a bit too inflammatory.
Wow. Maybe you should have asked him if he’s had any cognitive decline testing lately.
He’s a pretty terrible doctor, but he is a useful idiot… I needed him to get a number of blood tests that I wanted, and I also needed him to get me a CAC/CT scan. He refused the scan until he saw my sky high cholesterol…. At that point he couldn’t get me a scan quick enough… 
He’s also got what I see a lot of doctors have got: a big stomach and a lot of spare bodyfat. I have no doubt they follow their own advice and that is the result.
I heard Dave Feldman talking about the LMHR measurements. He said they had other data they were analyzing. He implied that everyone had atherosclerosis, to different degrees though.
Personally, I’m more concerned about coagulation than LDL. But I don’t (1) know how to measure this and (2) know how to reduce it.
In my last set of tests, my HS-CRP was 0.26 mg/l, and my GGT was 10 IU/l, and my Sedimentation Rate was 2 mm/hr, which is near the bottom of the reference interval. I assume that’s good from a coagulation perspective, but don’t know.