I don’t. I just hadn’t been to see one in over 12 years and figured it’d be good to get some kind of idea where my blood was. I was initially impressed with this guy because he didn’t jump straight into drugs when my wife first met with him.
Not too certain, but it’s at least worth having the conversation. I’m paying out the asshole for health insurance, may as well put some of that money to use. Right now it’s going into a black hole.
It doesn’t give a mechanistic reason for LDL being bad. It does highlight a lot of things you probably already know like lowering triglycerides, via LC and/or fasting etc.
Specifically I was thinking about the LDL section of the article wherein he states:
The statin drugs lower LDL cholesterol quite powerfully, and also reduces CV disease in high risk patients. But these drugs have other effects, often called the pleiotropic (affecting multiple systems) effects. For example, statins also reduce inflammation, as shown by the reduction in hsCRP, an inflammatory marker. So, is it the cholesterol lowering or the pleiotropic effects that are responsible for the benefits?
Then a paragraph or two later he goes on to briefly discuss a different type of LDL lowering drug.
A new class of drugs called the PCSK9 Inhibitors has the power to reduce LDL a lot. The question, though is whether there will be any CV benefit. Early indications are quite positive. But it is far from definitive. So the possibility exists that LDL may play a causal role here. This is, after all, why doctors worry so much about keeping LDL down.
My thinking is that going in to persuade your doctor that LDL is irrelevant to CVD risk may not be effective.
To be clear, I am not advocating to any kind of drug therapy at all, rather I’m just no longer convinced that the “LDL is meaningless” line of thought is complete or fully correct.
I agree with your idea of giving it another shot. You can easily point out that other risk factor metrics are looking really good (high HDL, low triglycerides, reduced bodyweight/body-fat, etc) and that you’d like to monitor the LDL situation for a good while before accepting any drug interventions he may suggest.
In my opinion #contextmatters. Dave Feldman has an ongoing cholesterol challenge to produce any studies that show LDL is independently athrogenic in an otherwise healthy population. So far he has no takers. Is LDL meaningless? Probably not. Should athletic low carbers with high LDL be worried? Probably not.
I feel that doing the Feldman protocol for this will be a waste of time, other than showing the doctor, hey look at how rapidly I can change my numbers.
Let’s see.
Let’s work some ratios:
HDL: 91
TRI: 64
LDL-C (calculated) 164
NON-HDL - 180
Tri:HDL = .7. Above 2 is a problem. You’re gold.
Your Non:HDL = 1.97. Pretty good there, too.
The sad things are… Cholesterol is poorly understood as a marker of coronary heart disease risk, and there is a sweet spot on the actuarial table for all cause mortality…
https://proteinpower.com/drmike/2007/02/02/statin-panic/
So, ultimately, talk to your doctor, say you are working on it with diet, and if he’s concerned, maybe you can take three months to get it squared by diet. When, for the retest, you do the Feldman protocol and put it in your rearview mirror for a year or two.
You mentioned getting those numbers down with a short term Feldman Binge, prior to a second test.
What is your reasoning for that?
If it is to get better numbers on paper, for a doc to see, and then go back to your usual WOE, that is basically manipulating results.
but I am wondering what you would achieve by it?If you genuinely aren’t bothered by your current cholesterol levels, then a 2nd test isn’t necessary.
And if you feel your numbers could be improved, then you can do that (I got my HDL higher by taking Krill Oil) but it would need to be a permanent change, so it circles back around to things being sustainable, and for YOU rather than about test results for a doc.
If your preference is to avoid statins, then that is very easy. You just say ‘No thank you.’
Docs see plenty of people who take this view nowadays, either because they doubt the statin claims, or to dodge the statin side effects. There are other options, drugs and supplements, if you prefer that route.
But it all comes back to what you want in the long term.
I find it interesting that in the case of the disease ALS it has been found that higher LDL (apparently without limit including values far beyond the normal range) correlates with slower progression and extended survival.
Exactly this. I don’t want this one number to be the determining factor in fucking up my future life insurance, or anything else that powers-that-be can use to hold over my head.
Is there any reason you have to listen to your doctor? Like for insurance reason?
My total cholesterol last test was 515! I don’t have the chart in front of me but of course my LDL’s were really high. I did have a CAC since I’m 66 and have 3 siblings have heart attacks. It came in at 0 no calcification. I had a Dexa scan and had less than a pound of fat around my organs. And my NMR came out really great.
My doctor definitely doesn’t understand but I told her I was the tip of the iceberg and she was going to see many like me in the following years.
If you are personally worried you might want to get these test done. They reassured me. I feel great.
I’m not worried about listening to the doctor, but I think it’s at least a good idea to attempt to have an informed discussion with him. If he doesn’t change his mind, then so what? I’ll manipulate the next test and be done with it for the year. At least that’s how it’s going in my head.
One thing that didn’t get tested was fasting insulin, as well as C reactive protein, both of these would have been good numbers to put the cholesterol stuff in context - at least in my head.
Hi Chris. Just browsing through all ZC threads including this one… Just wandering if it is appropriate to be nosy and ask what happened with you and Dr?
After my recent run in with an endocrinologist who I saw for Thyroid issues, and who then ordered a metric ton of lipid tests and basically only wanted to talk lipids and FH, I’ve decided that I’m declining to take a lipid profile again. If anyone wants to know what’s going on, they can order a CIMT or a CAC, and we can talk about plaque in place, should any exist, or we can forget it and focus on things I believe important.