Statins

[dornole]

Def seems like there are conflicting opinions out there on the best diet to reduce cholesterol (which I will loosely term the Paleo camp and the Ornish camp), both with evidence of about 40% reductions in LDL despite radical disagreement about the merits of protein, whole grain carbs, legumes and fruit.

But EVERYBODY agrees that sugar and white flour and transfat are bad (right?!) and vegetables are good. So my plan for the next six weeks is to avoid baked goods, desserts, pasta, and sugary drinks (which I never have anyway), continue the middle-road portion controlled diet I am on, continue eating a crap ton of veggies, and when I get that high-benefit thing done I can tweak things from there and CHOOSE MY DESTINY.

I am in indeed aware that I am overweight. A bit sad to have to do this over again but with patience and persistence I know I can improve. I was at a healthy weight for 4 years before gaining 40 lbs in about the last 18 months.

Wish my luck and send yourhealthy vibes to me! I'm glad you have ways of eating and moving that are giving you good health.

 

[AZ Don]

My father in law tried all the statins and finally had to stop due to significant side effects. He now takes Red Rice Yeast and his cholesterol is controlled with no side effects.

 

[AZ Don]

Def seems like there are conflicting opinions out there on the best diet to reduce cholesterol (which I will loosely term the Paleo camp and the Ornish camp), both with evidence of about 40% reductions in LDL despite radical disagreement about the merits of protein, whole grain carbs, legumes and fruit.

Ornish and Esselstyn have both scientifically demonstrated the heart disease reversing benefits of a plant based diet. I don't think that's true of the Paleo diet, though it is generally a significant improved over SAD - standard American diet.

 

[pellicle]

Ornish and Esselstyn have both scientifically demonstrated the heart disease reversing benefits of a plant based diet. .

a worthy read on this here:

http://cardiohub.org/wp-content/uplo...ngA12Year1.pdf

the first paragraph sets the tone:

Modern cardiology has given up on curing heart disease. Its aggressive interventions— coronary artery bypass graft, atherectomy, angioplasty, and stenting— do not reduce the frequency of new heart attacks or prolong survival except in small subsets of patients. For most patients these procedures do not treat life-threatening plaques. Thus, it is clear that the goal of cardiology has become the relief of pain and unpleasant symptoms in the face of progressive disability and often death from disease. It is time to call this approach by its true name: palliative cardiology. It is also time to acknowledge that this approach is not the only alternative for our patients

(PS: Don, to be clear, I am not contradicting you)

 

[cldlhd]

No fish? Did I read that right?

 

[cldlhd]

What if you get decent numbers while still eating meat? So how are my most recent numbers? Total cholesterol- 154, triglycerides-95, HDL-48, LDL- 87.

 

[pellicle]

What if you get decent numbers while still eating meat? So how are my most recent numbers? Total cholesterol- 154, triglycerides-95, HDL-48, LDL- 87.

then you aren't fitting that study cohort and you should roll around in it eating Bacon and Salmon weekly like I do ;-)

gotta be some positives in my DNA

 

[Paleowoman]

What if you get decent numbers while still eating meat? So how are my most recent numbers? Total cholesterol- 154, triglycerides-95, HDL-48, LDL- 87.

then you aren't fitting that study cohort and you should roll around in it eating Bacon and Salmon weekly like I do ;-)

gotta be some positives in my DNA

And what if you have high numbers like me (total 344, HDL 146, LDL 193, triglycerides 35) but don’'t have any heart disease, and eat meat and fish daily, plus a lot of veggies too ?

 

[pellicle]

And what if you have high numbers like me (total 344, HDL 146, LDL 193, triglycerides 35) but don’'t have any heart disease, and eat meat and fish daily, plus a lot of veggies too ?

Supports the view that we don't know enough yet to actually be sure of this stuff. Seems good for you too.

Which is why I normally am not interested in this topic...

 

[cldlhd]

Mmmm bacon

 

[Nocturne]

No fish? Did I read that right?

No fish, no nuts, no olive oil,
Not a single luxury!
Like Robinson Ca-rusoe,
As miserable as can be!

Ornish and Esselstyn's diets may work, but the people who need to go on them to survive already lost some sort of lottery, be it genetic, environmental, or just plain luck. Very few people can stick to the strict diet required to reverse CAC, and even those that do do not always succeed. And life is a cruel prankster, always ready with a funny gag like a fatal automobile accident after ten years of ascetic self-deprivation made in hopes of avoiding a heart attack thirty years down the road.

Don't forget Dr. Matthew Budoff and his work with aged garlic extract, which seems to slow CAC progression by about 50%. He is very well published and was nice enough to answer a private question I posed to him a short while back. Good guy in my book.

 

[Nocturne]

Supports the view that we don't know enough yet to actually be sure of this stuff. Seems good for you too.

Which is why I normally am not interested in this topic...

We really don't know half enough about this stuff yet. And there is a lot we may never know.

paleowoman, your HDL seems almost mutation level high. Your ratios are great even thought he raw numbers are high, which is no doubt why your docs are not concerned.

Unfortunately CAC has less to do with cholesterol levels than you'd expect, but you are covered there too, by your good scans.

 

[AZ Don]

a worthy read on this here:

http://cardiohub.org/wp-content/uplo...ngA12Year1.pdf

Pellicle, Good article, thanks for posting.

One key point I take from the article, that I have read elsewhere:

when serum cholesterol levels are maintained !150 mg/dl, coronary artery disease is practically nonexistent.

cldlhd, Although the article promotes a plant based diet, it also states the most important factor in avoiding heart disease is low cholesterol, so perhaps it doesn't matter how you get there.

Paleowoman, I have read statements based on other studies contradicting cholesterol as the key risk factor. As others have said, not enough is known yet. There may well be other ways to lower risk.

Very few people can stick to the strict diet required to reverse CAC, and even those that do do not always succeed.

Three comments on this. First, prevention is easier, and requires a less strict diet than stopping or reversing heart disease. I think it is Ornish that has separate criteria for prevention and stop/reverse. Second, entire cultures eat plant based diets that could be considered strict. Much of India and China. I doubt they feel deprived. I admit, having grown up on hamburgers, hot dogs, milk, cheesecake, etc, it is harder, but far from impossible. Third, Far too many people rely on their doctors to cure them of their illnesses while continuing the same behaviors that caused them. As the article points out, this does nothing to treat the cause of the disease, and so it does little to prolong life.

 

[Paleowoman]

We really don't know half enough about this stuff yet. And there is a lot we may never know.

paleowoman, your HDL seems almost mutation level high. Your ratios are great even thought he raw numbers are high, which is no doubt why your docs are not concerned.

Unfortunately CAC has less to do with cholesterol levels than you'd expect, but you are covered there too, by your good scans.

"Unfortunately CAC has less to do with cholesterol levels than you'd expect," - I know, I quote my choesterol numbers knowing, happily, that they have nothing to do with CAC, or even to do with heart disease. The cholesterol hypothesis of heart disease is being contradicte/overturned frequently. The causes of heart disease still not completely identified - but I have no risk factors apart from age.

"your HDL seems almost mutation level high." - no they're not high through mutation. Up to ten years ago my HDL was absolutley like most peoples', ie 77 (I keep a graph). Then I adopted a 'paleo' diet, ie, cut out all grain foods, all starchy foods, legumes, all sugars, I ate organically reared meat, which includes fatty cuts of beef, lamb, chicken, fish, but especially oily, wild fish, eggs, nuts, especially almonds and walnuts, lots of veggies (veggies with every meal inclucing breakfast, meat, fish or eggs with every meal including breakfast) and fats such as coconut oil, and a glass of red wine every supper . Year on year my HDL has risen steadily. Also do exercise !

 

[Paleowoman]

Paleowoman, I have read statements based on other studies contradicting cholesterol as the key risk factor. As others have said, not enough is known yet.

I know ! I'm not in the least concerned about my cholesterol levels as a risk factor for heart disease which is why I happily quote the levels My GP measures my levels six monthly because he is under the constraints of NICE (UK thing) directives. I have read so many doctors' studies and books which contradict the cholesterol hypothesis of heart disease. Even the top Framingham doctor did. I'm not even convinced about "good" cholesterol and "bad" cholesterol or "protective" lipid profiles ! The only thing I'll say is that the triglyceride level coould be indicative of inflammation - triglycerides aren't even cholesterol, they are the fats the liver makes from carbohydrates which are then transported in the bloodstream for storage. Inflammation is one of the biggests buzz words in the cardiac world as a risk factor for heart disease. High sensitivity CRP can measure that, though it's a non-specific test. Smoking increases inflammation as well as damaging the endothelium and decreasing levels of protective nitric oxide. Infection may be a risk factor too. And age is also a rsik factor for heart disease which none of us can avoid !

 

[Agian]

I have read so many doctors' studies and books which contradict the cholesterol hypothesis of heart disease.

Nonsense. We know high LDL is associated with coronary artery disease. People with FH have heart attacks in their 30s and people with hypobetalipoproteinaemia live an average of 15 years longer. Blogposts and quacks don't count as reputable sources.

Esselstyn and Ornish published studies showing vegan diets can reverse CAD. The two angiograms Dr Esselstyn uses as examples are: 1) From a man at a time before wide use of statins and 2) a colleague who refused to go on statins. If one was taking cholesterol-lowering medications AND eating vegan, we wouldn't know which was causing the reversal. However, vegans have a lower HDL. Dr Esselstyn thinks it's no big deal, because the LDL lowering is more significant. So, he indirectly makes a correlation between veganism and lipid profiles, which isn't immediately apparent in his talks. His diet comes as a 'package', which works. However, his arguments against oils aren't convincing. 'Good oils' increase HDL (Coconut oil isn't one of them).

70% of cholesterol is produced by the liver and doesn't come from food. However, saturated fats increase cholesterol production and Trigs (which correlate to body fat). Animal products are the biggest source of saturated fats, so there you go. You can go as hard as you need to, given your cardiac status. For a diabetic, a high carb diet is probably not a good idea. However, for someone else it might be a different story.

Lipids are only ONE risk factor, which allows some of the bananas out there to come out with various theories. If we lived the way we were meant to we wouldn't have these problems.

Inflammation, smoking, high homocysteine, lipids, LPA, diabetes, hypertension, obesity... probably many more.

 

[Agian]

constraints of NICE (UK thing) directives.

NICE is one big bureaucratic gravy-train, made up of 'health experts' (i.e., people with few qualifications).

 

[cldlhd]

I've read a bit about CRP and I know it can bounce around so it can be hard to know what your 'normal' is . I've had mine checked 3 times . Twice it was about the same but the other was a lot higher- can't remember if I was getting over being sick that time . On 2/27/14 - 1.3, 10/20/14 - 4.5 then on 1/19/15 - 1.2.

 

[Paleowoman]

Nonsense. We know high LDL is associated with coronary artery disease. People with FH have heart attacks in their 30s and people with hypobetalipoproteinaemia live an average of 15 years longer. Blogposts and quacks don't count as reputable sources.

High LDL is not associated with CAD - there are as many people with low LDL who get heart attacks as people with high LDL. I will not get links for those studies (except metaanalysis from BMJ lower down) because the supporters of the cholesterol hypothesis of heart disease call those studies unreputable and also add that LDL should therefore be lower, for example, here:

"A new national study (2009) has shown that nearly 75 percent of patients hospitalized for a heart attack had cholesterol levels that would indicate they were not at high risk for a cardiovascular event, based on current national cholesterol guidelines.
Specifically, these patients had low-density lipoprotein (LDL) cholesterol levels that met current guidelines, and close to half had LDL levels classified in guidelines as optimal (less than 100 mg/dL).
"Almost 75 percent of heart attack patients fell within recommended targets for LDL cholesterol, demonstrating that the current guidelines may not be low enough to cut heart attack risk in most who could benefit," said Dr. Gregg C. Fonarow, Eliot Corday Professor of Cardiovascular Medicine and Science at the David Geffen School of Medicine at UCLA and the study's principal investigator." http://newsroom.ucla.edu/releases/ma...ed-heart-75668

Here is a meta analysis of LDL is older patients showing no association between LDL levels and mortality: http://bmjopen.bmj.com/content/6/6/e010401.full

But if you just say that the authors are quacks the discussion is pointless isn't it ?

FH is a genetic condition which some people are born with which is not normal. We are not talking about the people with FH.

People with abnormally low levels of cholesterol die from other things such as infections and cancer.

 

[Paleowoman]

NICE is one big bureaucratic gravy-train, made up of 'health experts' (i.e., people with few qualifications).

Yes. One of my 'thinkiing' GPs called NICE the National Institute of Cost Effectiveness LOL