Another Statin-Pushing Doctor

      215 Comments on Another Statin-Pushing Doctor

The Older Brother’s oldest son (a.k.a. my nephew Eric) recently annoyed his (morbidly obese) doctor by refusing to take statins after a lab test flagged his total cholesterol as “elevated.”

Some snippets from an email Eric sent me:

The nurse called last night while I was driving home and only gave me my triglycerides and cholesterol readings, followed by the doctor’s (5 feet tall and a good 275lbs) recommendation to take a statin.

After verifying that she heard me correctly that “I’m not going to take a statin” and then informing me that cholesterol can lead to heart disease and stroke, I again declined and told her I would talk further with the doctor, recommending your movie and a couple books.

I called this morning to have the full results faxed to me.  After getting that fax from the machine with my greasy, McMuffin-without-the-muffin fingers (didn’t have time to make eggs this morning or a protein shake), I plugged them into excel to share.

Eric is 26 years old and (like his younger brother the Ranger) a strong, muscular guy who’s in excellent shape.  Here are the cholesterol numbers that prompted the obese doctor to recommend a statin:

Total Cholesterol:   219
HDL: 61
Triglycerides:  55
LDL:  147

The LDL, of course, is a calculated figure.  For those of you who don’t already know, LDL is usually calculated using something called the Freidewald Equation, which looks like this:

LDL = Total cholesterol – (HDL + (Triglycerides/5))

As Dr. Mike Eades explained in one his posts, the Freidewald equation has been shown to over-estimate LDL levels in people whose triglycerides are low.  The Freidewald equation also “rewards” you for having higher triglycerides – not something you want — by producing a lower calculated LDL figure.   Let’s create a couple of fictional examples to demonstrate:

Patient One
Total Cholesterol: 200
HDL: 45
Triglycerides:  150
Calculated LDL:  125

Patient Two
Total Cholesterol: 200
HDL: 50
Triglycerides:  70
Calculated LDL:  136

The most useful indicator of heart-disease risk you can extrapolate from a lipid panel is the ratio of Triglycerides/HDL.  You want that ratio below 2.0, because a ratio below 2.0 is a pretty good indicator that you’re mostly producing large, fluffy LDL.  At 3.0 or above, it’s more likely you’re producing small, dense LDL.

Patient One’s ratio is 3.33 — not horrible, but certainly not what I’d consider good, either.  Patient Two’s ratio is 1.4 —  pretty darned good.  Patient Two clearly has a much better cholesterol profile.  But because Patient Two’s calculated LDL (which is likely overestimated anyway) is above the supposed magic number of 130, she’s the one who’ll get a lecture from her doctor along with a recommendation to go on a low-fat diet – which will probably reduce her HDL and raise her triglycerides.

Eric’s Triglycerides/HDL ratio is 0.90 … in other words, it’s outstanding.  Even if his LDL is really and truly elevated, it’s almost certainly mostly the large, fluffy LDL.  That type of LDL not only isn’t dangerous, it protects us against infections and cancer, at least according to Dr. Uffe Ravnskov’s reading of the data.

And yet a doctor wants this strong, active, sports-nut of a 26-year-old man to go on statins because his total cholesterol is 219 and his calculated LDL is 147.  If Eric did go on statins, the only beneficiaries would be

  • Pfizer
  • The pitchers on opposing softball teams who would no longer have to watch Eric belt their fastballs over the fences

It’s a sad situation when we have to ignore our doctors’ advice in order to stay healthy.


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215 thoughts on “Another Statin-Pushing Doctor

  1. JuneBug

    I’d been on statins for two years. I’m a nurse, but it wasn’t until I read this blog that I realized that the god-awful leg cramps I was getting at night might not have been related to going low-carb (thanks, Tom) but to my daily 20mg of Simvastin. I stopped taking statins and my leg cramps improved greatly. Here were my labs after two months of no Simvastin and lots of butter, bacon, eggs, and red meat.

    Prior:
    Total: 219
    Triglycerides: 130
    HDL; 35
    VLDL: 30
    LDL: 128

    After
    Total : 240
    Triglycerides: 77
    HDL: 73
    VLDV: 15
    LDL: 152

    So, of course the recommendation was to go back on Simvastin, but on 20 mg TWICE a day. I had a lovely conversation with the nurse explaining that I wasn’t going back on statins at all. My triglycerides were way down, my HDL was way up, my ratio was fantastic, and they hadn’t done the particle density test that I had asked for so we had no idea what the LDL really meant. Besides, I was way more concerned about my hA1c, which was 5.9 mg. Of course the doctor didn’t think the hA1c was important and that I could always try a diabetic diet if I was worried (and we all know how helpful THAT would be). I agreed to come back in three months and get my bloods checked again. I’ve bought a blood glucose monitor and my fasting blood sugars are routinely over 120, so I’m hoping to have a more reasonable conversation about getting ahead of becoming a full-blown Type 2 diabetic.

    Your trig/HDL ratio is excellent now. Stick with the diet, and there’s a good chance the fasting glucose will come down too.

    Reply
  2. Walter B

    You said about statins, “They appear to provide a minor benefit for men under 65 with existing heart disease. However, I believe the same benefits could be derived through a change in diet, without the nasty side effects.”

    The benefit IIUC is limited to a small reduction in heart problems without a decline in deaths. After adjusting for so called side effects, I evaluate the benefit as negative.

    Perhaps the reduction of cholesterol by statins is a side effect.

    Any small benefit they provide is likely due to reducing inflammation.

    Reply
  3. Phyllis Mueller

    As I understand it, calculated LDL is the “industry standard” for blood lipid measurement. There also may be a follow-the-money aspect as more sophisticated equipment (and perhaps higher skilled workers) may be needed for particle size or direct measurement lab work. That would mean investing in better equipment and/or personnel or sending blood samples to an outside lab.

    I remember my husband’s (former) cardiologist explaining this in a conversation about being tested for CRP and homocysteine (tests his in-house lab did not do).

    Sure, the extra time and expense of a direct LDL measurement (with particle size) no doubt figures into it. I’m sure the pharmaceutical reps aren’t pushing for those either, since a lot of people with “high” cholesterol might end up deciding they don’t need statins.

    Reply
  4. Jason

    It’s not that most doctors/NPs don’t see the validity of particle size. It’s just that they don’t know what to DO with the numbers.

    My doctor is warming up to my repeated attempts to get him to read Good Calories/Bad Calories. A good friend had given him the book a few weeks before I scoffed at his recommendation to take statins and showed him the book. I had asked for an NMR, and his comment when telling me I should take statins was “well, I asked the rep when they were pushing the NMR: ‘what do we do differently, based on these numbers’ and the rep couldn’t tell me.”

    I told him that _I_ knew what to do: eat more fat, fewer to no carbohydrates, test and correct blood vitamin d3 levels, and take fish oil twice a day–which I’ve been doing for only about three months before the NMR.

    He nodded and said that we should redo the test in a few months and see if I’m right. I hope my numbers improve because I’ve almost got a convert.

    Glad he’s being open-minded about it.

    Reply
  5. Janknitz

    My sister-in-law asked me if I was taking statins because of high blood pressure. She did not seem to believe me when I told her I brought my blood pressure down from diet alone and would not take statins, EVER, because there is no evidence that they are effective in women at all.

    Her response was “well, my cholesterol is coming down”. But she didn’t know what components of her cholesterol were coming down (what if it was the HDL?), or whether or not changes to her diet (not decreasing carbs, that’s for sure) might explain it. She’s a very intelligent person, but people just take these drugs like sheep when the doctors prescribe them.

    What do statins have to do with high blood pressure anyway? They’ve never been shown to be beneficial to women of any age.

    Reply
  6. JuneBug

    I’d been on statins for two years. I’m a nurse, but it wasn’t until I read this blog that I realized that the god-awful leg cramps I was getting at night might not have been related to going low-carb (thanks, Tom) but to my daily 20mg of Simvastin. I stopped taking statins and my leg cramps improved greatly. Here were my labs after two months of no Simvastin and lots of butter, bacon, eggs, and red meat.

    Prior:
    Total: 219
    Triglycerides: 130
    HDL; 35
    VLDL: 30
    LDL: 128

    After
    Total : 240
    Triglycerides: 77
    HDL: 73
    VLDV: 15
    LDL: 152

    So, of course the recommendation was to go back on Simvastin, but on 20 mg TWICE a day. I had a lovely conversation with the nurse explaining that I wasn’t going back on statins at all. My triglycerides were way down, my HDL was way up, my ratio was fantastic, and they hadn’t done the particle density test that I had asked for so we had no idea what the LDL really meant. Besides, I was way more concerned about my hA1c, which was 5.9 mg. Of course the doctor didn’t think the hA1c was important and that I could always try a diabetic diet if I was worried (and we all know how helpful THAT would be). I agreed to come back in three months and get my bloods checked again. I’ve bought a blood glucose monitor and my fasting blood sugars are routinely over 120, so I’m hoping to have a more reasonable conversation about getting ahead of becoming a full-blown Type 2 diabetic.

    Your trig/HDL ratio is excellent now. Stick with the diet, and there’s a good chance the fasting glucose will come down too.

    Reply
  7. Brooke

    Help! Just got my lab results back, after being on a HFLC diet since April…my HDL went from 47 to 52. LDL went from 138 to 193!!!???? Trig. was 120, now 95. Doctor wants me to come in for appt next week. Shall I come armed with all of my “statins can kill” info? Thanks! I’m kinda freaking out over that LDL number!

    The LDL was probably calculated. And even it’s that high, it’s not the number that matters, it’s the particle size.

    Reply
  8. Janknitz

    My sister-in-law asked me if I was taking statins because of high blood pressure. She did not seem to believe me when I told her I brought my blood pressure down from diet alone and would not take statins, EVER, because there is no evidence that they are effective in women at all.

    Her response was “well, my cholesterol is coming down”. But she didn’t know what components of her cholesterol were coming down (what if it was the HDL?), or whether or not changes to her diet (not decreasing carbs, that’s for sure) might explain it. She’s a very intelligent person, but people just take these drugs like sheep when the doctors prescribe them.

    What do statins have to do with high blood pressure anyway? They’ve never been shown to be beneficial to women of any age.

    Reply
  9. Brooke

    Question…so if one’s LDL is of the “fluffy” variety, acting as a “protectant”, would that mean that the higher this fluffy LDL number the better? So then I should actually be CELEBRATING my 193 LDL??? (hoping and praying this is the case!) Thanks again Tom! (or anyone else who’d care to comment!)

    Yes, if you have a lot of large, fluffy LDL, you should celebrate. It’s protective. Among older people, those with “high” cholesterol have the longest lifespans, probably because cholesterol protects again infections and cancer. One of the little-publicized findings of the Framingham study was that people whose cholesterol dropped as they got older were more likely to die at a younger age. Back before antibiotics, when infections were the number one cause of death, people with the highest cholesterol were the least likely to die from infections.

    Reply
  10. Brooke

    Help! Just got my lab results back, after being on a HFLC diet since April…my HDL went from 47 to 52. LDL went from 138 to 193!!!???? Trig. was 120, now 95. Doctor wants me to come in for appt next week. Shall I come armed with all of my “statins can kill” info? Thanks! I’m kinda freaking out over that LDL number!

    The LDL was probably calculated. And even it’s that high, it’s not the number that matters, it’s the particle size.

    Reply
  11. Brooke

    Question…so if one’s LDL is of the “fluffy” variety, acting as a “protectant”, would that mean that the higher this fluffy LDL number the better? So then I should actually be CELEBRATING my 193 LDL??? (hoping and praying this is the case!) Thanks again Tom! (or anyone else who’d care to comment!)

    Yes, if you have a lot of large, fluffy LDL, you should celebrate. It’s protective. Among older people, those with “high” cholesterol have the longest lifespans, probably because cholesterol protects again infections and cancer. One of the little-publicized findings of the Framingham study was that people whose cholesterol dropped as they got older were more likely to die at a younger age. Back before antibiotics, when infections were the number one cause of death, people with the highest cholesterol were the least likely to die from infections.

    Reply
  12. Brooke

    Thanks Tom. I am seriously considering canceling Monday’s appt with my (clueless) PCP, and instead going with one listed in my state below.. (thanks Jimmy Moore!) I don’t need the rise in blood pressure, just thinking of how that appointment would go…he’d want me to put me on BP medication AS WELL as statins!

    http://lowcarbdoctors.blogspot.com/

    Sounds worth the drive to me.

    Reply
  13. Brooke

    OK, now I’m really worried. (sorry for the multiple posts!) I just picked up my lab report. Why is my A1-C “prediabetic”? (5.8) Same as last year. Why is my glucose level high? (102) Last year it ranged from 99 to 112.
    I don’t understand. Been eating HFLC since May. Gave up sugar, grains, pasta and the only fruits have been either an occasional apple or berries.
    I don’t know what else I can give up. Very disappointing. But yet I’ve never felt better physically! Go figure..

    I’d say it’s time to see a good doctor who understands the benefits of low-carb and get some some tests done. Some people, no matter how strictly they observe a low-carb diet, still need medication if their pancreas just can’t do the job anymore.

    Reply
  14. Brooke

    Thanks Tom. I am seriously considering canceling Monday’s appt with my (clueless) PCP, and instead going with one listed in my state below.. (thanks Jimmy Moore!) I don’t need the rise in blood pressure, just thinking of how that appointment would go…he’d want me to put me on BP medication AS WELL as statins!

    http://lowcarbdoctors.blogspot.com/

    Sounds worth the drive to me.

    Reply
  15. Brooke

    OK, now I’m really worried. (sorry for the multiple posts!) I just picked up my lab report. Why is my A1-C “prediabetic”? (5.8) Same as last year. Why is my glucose level high? (102) Last year it ranged from 99 to 112.
    I don’t understand. Been eating HFLC since May. Gave up sugar, grains, pasta and the only fruits have been either an occasional apple or berries.
    I don’t know what else I can give up. Very disappointing. But yet I’ve never felt better physically! Go figure..

    I’d say it’s time to see a good doctor who understands the benefits of low-carb and get some some tests done. Some people, no matter how strictly they observe a low-carb diet, still need medication if their pancreas just can’t do the job anymore.

    Reply
  16. Brooke

    Thanks Tom…
    I also had my CRP checked…”11″…not good. Sign of inflammation. (level should be under 5) Wondering if maybe I’d been eating TOO MUCH fat and protein or just not enough fruits and veggies to balance it out. Found this..I feel there is some validity to it…

    Carbohydrates and Fats
    According to Virginia Tech researchers, the ratio of carbohydrates to fats has a significant effect on C-reactive protein. In a 2007 study published in the “Journal of the American College of Nutrition,” Janet W. Rankin, PhD and Abigail D. Turpyn observed 29 overweight women randomly assigned to either a low-carbohydrate, high-fat diet, dubbed LC, or a high-carbohydrate, low-fat diet, designated HC, while caloric values remained similar between both groups. After four weeks, the LC group lost more weight but experienced a 25 percent increase in C-reactive protein levels, while levels in the HC group decreased 43 percent.

    Read more: http://www.livestrong.com/article/305780-c-reactive-protein-diet/#ixzz1auHoJfNu

    Reply
  17. Drew @ Willpower Is For Fat Pe

    @Brooke, you also might want to re-think your definition of “success”. Your numbers are the same as last year — meaning they haven’t gotten any worse, despite eating what most mainstream docs tell you you shouldn’t eat — and you’ve never felt better.

    Maybe it’s just me and low standards, but that sounds like a good outcome to me.

    Reply
  18. Brooke

    Thanks Tom…
    I also had my CRP checked…”11″…not good. Sign of inflammation. (level should be under 5) Wondering if maybe I’d been eating TOO MUCH fat and protein or just not enough fruits and veggies to balance it out. Found this..I feel there is some validity to it…

    Carbohydrates and Fats
    According to Virginia Tech researchers, the ratio of carbohydrates to fats has a significant effect on C-reactive protein. In a 2007 study published in the “Journal of the American College of Nutrition,” Janet W. Rankin, PhD and Abigail D. Turpyn observed 29 overweight women randomly assigned to either a low-carbohydrate, high-fat diet, dubbed LC, or a high-carbohydrate, low-fat diet, designated HC, while caloric values remained similar between both groups. After four weeks, the LC group lost more weight but experienced a 25 percent increase in C-reactive protein levels, while levels in the HC group decreased 43 percent.

    Read more: http://www.livestrong.com/article/305780-c-reactive-protein-diet/#ixzz1auHoJfNu

    Reply
  19. Drew @ Willpower Is For Fat People

    @Brooke, you also might want to re-think your definition of “success”. Your numbers are the same as last year — meaning they haven’t gotten any worse, despite eating what most mainstream docs tell you you shouldn’t eat — and you’ve never felt better.

    Maybe it’s just me and low standards, but that sounds like a good outcome to me.

    Reply
  20. Mari

    Interesting. I am a 22 year old female…I had my first comprehensive blood work earlier this year. My calculated LDL was 187, but my triglycerides were 52 and my HDL was 64, making my trig/HDL = 0.8125. Fortunately my doctor didn’t even comment on my “high” cholesterol…my mom was prescribed statins several years ago by a different doctor, and her liver and muscles were permanently damaged as a result of taking them.

    I’m sorry to hear about your mom. Statins are awful drugs.

    Reply
  21. Mari

    Interesting. I am a 22 year old female…I had my first comprehensive blood work earlier this year. My calculated LDL was 187, but my triglycerides were 52 and my HDL was 64, making my trig/HDL = 0.8125. Fortunately my doctor didn’t even comment on my “high” cholesterol…my mom was prescribed statins several years ago by a different doctor, and her liver and muscles were permanently damaged as a result of taking them.

    I’m sorry to hear about your mom. Statins are awful drugs.

    Reply
  22. Josh

    Brooke: please read this article http://chriskresser.com/why-hemoglobin-a1c-is-not-a-reliable-marker

    Also note that eating VLC can raise your fasting glucose by causing a type of insulin resistance and by promoting gluconeogenesis. I’m not sure how much it matters. Perhaps it does, and then the solution would be to increase your carb consumption very slightly with safe starches (sweet potatoes etc) or some lower fructose fruits (eg oranges but not watermelon). Increasing carbs may also cause thyroid hormone upregulation(probably a good thing); some people who plateau on weightloss on VLC find they start losing weight again if they go up in carbs (moderate increases, nothing crazy). The amount is very individual and you will need to experiment. If you are currently at 20grams of carbs, go up to 50; at 50, go to 75, etc) Something like 100grams per day seems to be a sweet spot for some people but some people gain weight and/or get hungrier well before 100g. Again, experiment.

    You may also want to make sure you’re getting enough protein, ie if your only calorie source is cream, you may want to decrease fat calories and increase protein calories by an equal amount.

    Try to remember that the test numbers are just rough indicators. If you feel better, you probably are better off. I’m not a doctor but I’ve got 100s of hours of reading and research on this topic; I doubt you need any sort of diabetes drugs. You would need some more tests like a glucose tolerance test and/or fasting insulin to be sure and most doctors would likely not want to run those on you because your numbers are “normal.” If it turns out you have slightly impaired glucose metabolism, metformin is probably the best drug out there for that. You will probably need a low carb aware doctor to prescribe you metformin with your numbers as good as they are.

    However, I’m willing to bet that your fasting glucose would go down if you increased carbs slightly. A1C isn’t reliable for paleo low carbers and becomes less and less reliable as the score gets lower. Check out the link I posted and listen to Robb Wolf’s podcast. And don’t worry! Worrying raises cortisol and that’s all kinds of bad 😉

    Reply
  23. Brooke

    @Josh..Thank you so much for the info! I feel better now. 🙂 I will definitely check out the link when I have the time. I did come across several articles such as the one below:

    “The foods that cause inflammation are organ meats, egg yolks (Unbroken egg yolks are fine. When the yolks are broken when you scramble them the cholesterol in the yolks are then oxidized. The yolks then produce toxic cholesterol by-products. It is important to keep the yolks in tact. So poach or hard boil them).

    Now back to why egg yolks, meat and some dairy are inflammatory.

    This is because of the arachidonic acid they contain. Arachidonic acid is a fatty acid that is essential to our life, but we do not need large amounts of it. In large amounts it is very bad for our health. ”

    This MAY have something to do with the high CRP as well…I had a three-egg omelette every morning for MONTHS along with extra crispy bacon. I suspect my “arachidonic” level must have been sky high! I am modifying my diet…sunny side up it is!
    Thanks again, Josh!

    Reply
    1. Wendy

      Seriously???? Eggs are eggs. What’s the difference how they are cooked, as long as they ARE cooked? I was just getting hopeful with this site, then I read that!

      Reply
  24. Josh

    Brooke: please read this article http://chriskresser.com/why-hemoglobin-a1c-is-not-a-reliable-marker

    Also note that eating VLC can raise your fasting glucose by causing a type of insulin resistance and by promoting gluconeogenesis. I’m not sure how much it matters. Perhaps it does, and then the solution would be to increase your carb consumption very slightly with safe starches (sweet potatoes etc) or some lower fructose fruits (eg oranges but not watermelon). Increasing carbs may also cause thyroid hormone upregulation(probably a good thing); some people who plateau on weightloss on VLC find they start losing weight again if they go up in carbs (moderate increases, nothing crazy). The amount is very individual and you will need to experiment. If you are currently at 20grams of carbs, go up to 50; at 50, go to 75, etc) Something like 100grams per day seems to be a sweet spot for some people but some people gain weight and/or get hungrier well before 100g. Again, experiment.

    You may also want to make sure you’re getting enough protein, ie if your only calorie source is cream, you may want to decrease fat calories and increase protein calories by an equal amount.

    Try to remember that the test numbers are just rough indicators. If you feel better, you probably are better off. I’m not a doctor but I’ve got 100s of hours of reading and research on this topic; I doubt you need any sort of diabetes drugs. You would need some more tests like a glucose tolerance test and/or fasting insulin to be sure and most doctors would likely not want to run those on you because your numbers are “normal.” If it turns out you have slightly impaired glucose metabolism, metformin is probably the best drug out there for that. You will probably need a low carb aware doctor to prescribe you metformin with your numbers as good as they are.

    However, I’m willing to bet that your fasting glucose would go down if you increased carbs slightly. A1C isn’t reliable for paleo low carbers and becomes less and less reliable as the score gets lower. Check out the link I posted and listen to Robb Wolf’s podcast. And don’t worry! Worrying raises cortisol and that’s all kinds of bad 😉

    Reply
  25. Brooke

    @Josh..Thank you so much for the info! I feel better now. 🙂 I will definitely check out the link when I have the time. I did come across several articles such as the one below:

    “The foods that cause inflammation are organ meats, egg yolks (Unbroken egg yolks are fine. When the yolks are broken when you scramble them the cholesterol in the yolks are then oxidized. The yolks then produce toxic cholesterol by-products. It is important to keep the yolks in tact. So poach or hard boil them).

    Now back to why egg yolks, meat and some dairy are inflammatory.

    This is because of the arachidonic acid they contain. Arachidonic acid is a fatty acid that is essential to our life, but we do not need large amounts of it. In large amounts it is very bad for our health. ”

    This MAY have something to do with the high CRP as well…I had a three-egg omelette every morning for MONTHS along with extra crispy bacon. I suspect my “arachidonic” level must have been sky high! I am modifying my diet…sunny side up it is!
    Thanks again, Josh!

    Reply
    1. Wendy

      Seriously???? Eggs are eggs. What’s the difference how they are cooked, as long as they ARE cooked? I was just getting hopeful with this site, then I read that!

      Reply
  26. goober1223

    I had a similar experience at my doctor’s office recently. The funny thing to me is that they know that I had a history of rhabdomyolysis, and yet they’d prefer to trigger that over the possibility of heart disease later on (based on faulty science). I don’t see a reason to switch doctors until they try to force the issue.

    Reply
  27. goober1223

    I had a similar experience at my doctor’s office recently. The funny thing to me is that they know that I had a history of rhabdomyolysis, and yet they’d prefer to trigger that over the possibility of heart disease later on (based on faulty science). I don’t see a reason to switch doctors until they try to force the issue.

    Reply
  28. Josh

    @Brooke: It seems that you have some major inflammation going on, but I don’t think the foods you listed are necessarily the cause. A cardio/high sensitivity CRP of 11mg/L is off the chart high unless you had an infection or some other insult on the system at the time. I was on a VLC, very high fat diet for at least six months that included 4-6 eggs fried in bacon grease plus 1/2 pound of bacon on most mornings. My CRP was 2.2. Less than 1 is ideal, 1-3 is intermediate risk, and greater than 3-10 is high absolute risk. Anything above 10 is usually caused by systemic inflammation, pregnancy or infection. If you were sick when you had the test done, I might go for another one to make sure your levels weren’t elevated because of that. For the record, the rest of my stats: TC calculated 213, trigs 84, hdl 55, ldl calculated 141. And yes, my doctor (who even believes in low carb) wanted to put me on a statin=no thanks.

    Reading http://en.wikipedia.org/wiki/Arachidonic_acid#Dietary_arachidonic_acid_and_inflammation it seems that arachidonic acid can be both pro and anti inflammatory. According to http://www.marksdailyapple.com/arachidonic-acid/ (which you probably want to read) an egg has about 390mg of AA so 3 eggs would put you at about 1200mg. I’m not sure about bacon but most people only have a few pieces anyway. According to the wikipedia article “Arachidonic acid supplementation in daily dosages of 1,000-1,500 mg for 50 days has been well tolerated during several clinical studies…” However, “Individuals suffering from joint pains or active inflammatory disease may find that increased arachidonic acid consumption exacerbates symptoms.” Additionally, Mark says “Much of people’s AA content is likely determined by (and derived from) their high linoleic acid intake (in the forms of corn, soy and vegetable oils).”

    So, my next question about your diet would be do you normally eat any vegetable oils or any processed foods? Store bought low-carb shakes all seem to have sunflower oil. Almonds or other nuts? Peanut butter? If yes, then I think that’s somewhere you can definitely start cutting. But either way, we need to look deeper. Also, if you still want to eat eggs, I’d try to source some non-factory raised chicken eggs which will have a better fat composition.

    The fact that AA is linked to inflammation, particularly that combining an existing source of inflammation with a diet high in AA raises inflammatory markers leads me to believe that if you lowered your AA consumption, your CRP scored would indeed go down but that it would still be way too high. Which is to say, AA isn’t your real problem, something else is causing you to be inflamed. On the dietary front, make sure you are familiar w/ the Paleo/Primal diet (not just low carb) and that you are following it strictly. This goes especially for gluten and vegetable oils but, if you’ve already eliminated them you might want to try the strict, autoimmunity elimination diet for a month or three to see if that helps you out. Medically, there are a lot of possibilities and I recommend that you consult with a health care practitioner that has a clue about inflammation and autoimmunity in a medical context. There may yet be some tweaking you can do with your diet to clear this up but, as Tom said, some people really do need medical intervention and that’s OK.

    If you don’t think you can find a good doctor easily, you might consider doing a phone consult with Chris Kresser. I have not done this myself so I can’t vouch for his services from experience, but from reading his blog and listening to him on various podcasts, he seems like he’d be a better option than your typical doctor. He will do a free, 15 minute consult http://chriskresser.com/clinic/appointment and the prices for his regular services are here http://chriskresser.com/clinic/services Even if you think you can’t afford his prices (which are a lot, but reasonable especially given the testing), the free 15 minute consult seems like a win-win. Good luck!

    Reply
  29. Josh

    @Brooke: It seems that you have some major inflammation going on, but I don’t think the foods you listed are necessarily the cause. A cardio/high sensitivity CRP of 11mg/L is off the chart high unless you had an infection or some other insult on the system at the time. I was on a VLC, very high fat diet for at least six months that included 4-6 eggs fried in bacon grease plus 1/2 pound of bacon on most mornings. My CRP was 2.2. Less than 1 is ideal, 1-3 is intermediate risk, and greater than 3-10 is high absolute risk. Anything above 10 is usually caused by systemic inflammation, pregnancy or infection. If you were sick when you had the test done, I might go for another one to make sure your levels weren’t elevated because of that. For the record, the rest of my stats: TC calculated 213, trigs 84, hdl 55, ldl calculated 141. And yes, my doctor (who even believes in low carb) wanted to put me on a statin=no thanks.

    Reading http://en.wikipedia.org/wiki/Arachidonic_acid#Dietary_arachidonic_acid_and_inflammation it seems that arachidonic acid can be both pro and anti inflammatory. According to http://www.marksdailyapple.com/arachidonic-acid/ (which you probably want to read) an egg has about 390mg of AA so 3 eggs would put you at about 1200mg. I’m not sure about bacon but most people only have a few pieces anyway. According to the wikipedia article “Arachidonic acid supplementation in daily dosages of 1,000-1,500 mg for 50 days has been well tolerated during several clinical studies…” However, “Individuals suffering from joint pains or active inflammatory disease may find that increased arachidonic acid consumption exacerbates symptoms.” Additionally, Mark says “Much of people’s AA content is likely determined by (and derived from) their high linoleic acid intake (in the forms of corn, soy and vegetable oils).”

    So, my next question about your diet would be do you normally eat any vegetable oils or any processed foods? Store bought low-carb shakes all seem to have sunflower oil. Almonds or other nuts? Peanut butter? If yes, then I think that’s somewhere you can definitely start cutting. But either way, we need to look deeper. Also, if you still want to eat eggs, I’d try to source some non-factory raised chicken eggs which will have a better fat composition.

    The fact that AA is linked to inflammation, particularly that combining an existing source of inflammation with a diet high in AA raises inflammatory markers leads me to believe that if you lowered your AA consumption, your CRP scored would indeed go down but that it would still be way too high. Which is to say, AA isn’t your real problem, something else is causing you to be inflamed. On the dietary front, make sure you are familiar w/ the Paleo/Primal diet (not just low carb) and that you are following it strictly. This goes especially for gluten and vegetable oils but, if you’ve already eliminated them you might want to try the strict, autoimmunity elimination diet for a month or three to see if that helps you out. Medically, there are a lot of possibilities and I recommend that you consult with a health care practitioner that has a clue about inflammation and autoimmunity in a medical context. There may yet be some tweaking you can do with your diet to clear this up but, as Tom said, some people really do need medical intervention and that’s OK.

    If you don’t think you can find a good doctor easily, you might consider doing a phone consult with Chris Kresser. I have not done this myself so I can’t vouch for his services from experience, but from reading his blog and listening to him on various podcasts, he seems like he’d be a better option than your typical doctor. He will do a free, 15 minute consult http://chriskresser.com/clinic/appointment and the prices for his regular services are here http://chriskresser.com/clinic/services Even if you think you can’t afford his prices (which are a lot, but reasonable especially given the testing), the free 15 minute consult seems like a win-win. Good luck!

    Reply
  30. Brian Edwards MD

    I just saw Fat Head. Excellent movie. I have been on a low carb diet since reading Taubes book Why We Get Fat.
    I am a lipidologist and I have given many statins to good effect.
    I would like to be a bridge between the low carb people and the Docs who give statins.
    I have not read all the comments but I have not seen the non-HDL cholesterol mentioned.
    I have not seen apoB and LDL-P mentioned.
    In my book, The Tubby Theory from Topeka, I advise that people with at least one risk factor get a CIMT and CAC to find out if they have plaque.
    Contrary to the movie, I think the Jupiter trial has shown statins help women.
    Also, please look at the AIM HIGH trial. It showed no difference in treating the triglycerides and low HDL-C with niacin in people already treated to goal with statins.
    Most importantly, in the AIM high trial, both arms had only a 15% incidence of cardiovascular events. That is simply amazing.
    Check out the two trials: Jupiter and AIM HIGH.

    I already have. Check out these, doctor:

    http://www.newswithviews.com/Ellison/shane144.htm

    http://ang.sagepub.com/content/61/1/119.extract

    http://junkfoodscience.blogspot.com/2008/11/when-news-sounds-too-good-statins-new.html

    http://www.proteinpower.com/drmike/cardiovascular-disease/1853/

    “In the category Family history of premature CHD (coronary heart disease) we see that there are 51 more subjects with a family history of premature CHD in the placebo group than in the Crestor group. Since a family history of premature CHD is probably the strongest risk factor for developing premature CHD, do you think a few more of the subjects in the placebo group may have developed it? And maybe died as a result?”

    Reply
  31. Brian Edwards MD

    I just saw Fat Head. Excellent movie. I have been on a low carb diet since reading Taubes book Why We Get Fat.
    I am a lipidologist and I have given many statins to good effect.
    I would like to be a bridge between the low carb people and the Docs who give statins.
    I have not read all the comments but I have not seen the non-HDL cholesterol mentioned.
    I have not seen apoB and LDL-P mentioned.
    In my book, The Tubby Theory from Topeka, I advise that people with at least one risk factor get a CIMT and CAC to find out if they have plaque.
    Contrary to the movie, I think the Jupiter trial has shown statins help women.
    Also, please look at the AIM HIGH trial. It showed no difference in treating the triglycerides and low HDL-C with niacin in people already treated to goal with statins.
    Most importantly, in the AIM high trial, both arms had only a 15% incidence of cardiovascular events. That is simply amazing.
    Check out the two trials: Jupiter and AIM HIGH.

    I already have. Check out these, doctor:

    http://www.newswithviews.com/Ellison/shane144.htm

    http://ang.sagepub.com/content/61/1/119.extract

    http://junkfoodscience.blogspot.com/2008/11/when-news-sounds-too-good-statins-new.html

    http://www.proteinpower.com/drmike/cardiovascular-disease/1853/

    “In the category Family history of premature CHD (coronary heart disease) we see that there are 51 more subjects with a family history of premature CHD in the placebo group than in the Crestor group. Since a family history of premature CHD is probably the strongest risk factor for developing premature CHD, do you think a few more of the subjects in the placebo group may have developed it? And maybe died as a result?”

    Reply
  32. Brooke

    Thank you Josh…you’re a wealth of information! I appreciate the time and energy you put into your response. 🙂 Yes, there IS something else going on…bleeding gums, for a while now…months. There’s a strong correlation between gum disease and elevated CRP. (been spending a little time on the web lately!) Now what’s causing the gum issue…well could very well be a lack of Vit C…which honestly I haven’t been consuming enough of…used to drink a lot of OJ, was into juicing, etc…eliminated that from my diet since April. There is a link between Vit C deficiency and gum disease (according to my research). This may sound a bit “out there” but a couple of months ago my medical intuitive/clairvoyant friend had seen “inflammation” and asked me if my gums bled. Freaked me out. She kept getting “C”..increase the Vit C. But I didn’t heed her advice until a week ago, after my research..I like to back up what she says with science. SO, I’m starting there…with the mouth. Dentist appt in a couple weeks. I’m already seeing improvement after a week on 2000 mg C daily. I will re-test in a couple months. If still elevated, I will ask for additional testing. Thanks again!

    Reply
  33. Brooke

    Forgot to add…I also have a little arthritis going on in my left knee…that as well will cause elevation in CRP.

    Reply
  34. Hannah

    Thanks for posting this! My husband just got his cholesterol numbers back and was upset his LDL was “so high” at 123. But his triglycerides were 47 and his HDL 61. It sounds like he’s in the same boat as Eric! Now if only doctors knew how to better interpret cholesterol test results rather than seeing something out of range and instantly resorting to medications.

    That’s an excellent ratio. I wouldn’t worry about the “high” LDL at all.

    Reply
  35. Brooke

    Thank you Josh…you’re a wealth of information! I appreciate the time and energy you put into your response. 🙂 Yes, there IS something else going on…bleeding gums, for a while now…months. There’s a strong correlation between gum disease and elevated CRP. (been spending a little time on the web lately!) Now what’s causing the gum issue…well could very well be a lack of Vit C…which honestly I haven’t been consuming enough of…used to drink a lot of OJ, was into juicing, etc…eliminated that from my diet since April. There is a link between Vit C deficiency and gum disease (according to my research). This may sound a bit “out there” but a couple of months ago my medical intuitive/clairvoyant friend had seen “inflammation” and asked me if my gums bled. Freaked me out. She kept getting “C”..increase the Vit C. But I didn’t heed her advice until a week ago, after my research..I like to back up what she says with science. SO, I’m starting there…with the mouth. Dentist appt in a couple weeks. I’m already seeing improvement after a week on 2000 mg C daily. I will re-test in a couple months. If still elevated, I will ask for additional testing. Thanks again!

    Reply
  36. Hannah

    Thanks for posting this! My husband just got his cholesterol numbers back and was upset his LDL was “so high” at 123. But his triglycerides were 47 and his HDL 61. It sounds like he’s in the same boat as Eric! Now if only doctors knew how to better interpret cholesterol test results rather than seeing something out of range and instantly resorting to medications.

    That’s an excellent ratio. I wouldn’t worry about the “high” LDL at all.

    Reply
  37. brooke

    Whew! Found this on Dr. Willliam Davis’s website:

    A high C-reactive protein (>0.5 mg/l) suggests that inflammation may be a contributor to growth of coronary atherosclerotic plaque. It can also act as a trigger for heart attack. Inflammation is the fuel for the fire that leads to coronary plaque rupture, the event that results in heart attack. Inflammation also drives other conditions like diabetes, cancer, and arthritis. While very high C-reactive protein levels >10 mg/l nearly always represent inflammation outside of the heart (e.g., arthritis) and do not necessarily indicate increased coronary risk, lower levels (<10 mg/l) can be used to gauge low-grade inflammation that stimulates coronary plaque activity.

    Reply
  38. brooke

    Whew! Found this on Dr. Willliam Davis’s website:

    A high C-reactive protein (>0.5 mg/l) suggests that inflammation may be a contributor to growth of coronary atherosclerotic plaque. It can also act as a trigger for heart attack. Inflammation is the fuel for the fire that leads to coronary plaque rupture, the event that results in heart attack. Inflammation also drives other conditions like diabetes, cancer, and arthritis. While very high C-reactive protein levels >10 mg/l nearly always represent inflammation outside of the heart (e.g., arthritis) and do not necessarily indicate increased coronary risk, lower levels (<10 mg/l) can be used to gauge low-grade inflammation that stimulates coronary plaque activity.

    Reply
  39. Dorian

    When a lipid test result says my HDL Cholesterol is 81, what are they actually measuring? Is it the HDL particle density, or is it cholesterol molecule density?

    That’s just the measurement of your HDL level — which is excellent, by the way. Particle size matters for LDL.

    Reply
  40. Dorian

    When a lipid test result says my HDL Cholesterol is 81, what are they actually measuring? Is it the HDL particle density, or is it cholesterol molecule density?

    That’s just the measurement of your HDL level — which is excellent, by the way. Particle size matters for LDL.

    Reply
  41. Kelli

    I am a nurse practitioner and I can tell you that statins are prescribed not solely on the basis of numbers. A huge part of whether statins are recommended is whether the patient has risk factors. If you are diabetic, if you have heart disease or peripheral vascular disease, etc. then a statin would be recommended to get your LDL less than 100.
    The doctor who tried to give the young healthy man statins is NOT following national guidelines and needs to get educated.
    The FIRST step in cholesterol management is lifestyle changes. I completely agree that a diet based in fruits/veg and meat is the best choice. I love your documentary and I love this website, please continue to get the word out. I know I will.

    I’m afraid that doctor isn’t at all unusual. Pretty much everyone I know with “high” cholesterol has had statins pushed on them by doctors.

    Reply
  42. Kelli

    I am a nurse practitioner and I can tell you that statins are prescribed not solely on the basis of numbers. A huge part of whether statins are recommended is whether the patient has risk factors. If you are diabetic, if you have heart disease or peripheral vascular disease, etc. then a statin would be recommended to get your LDL less than 100.
    The doctor who tried to give the young healthy man statins is NOT following national guidelines and needs to get educated.
    The FIRST step in cholesterol management is lifestyle changes. I completely agree that a diet based in fruits/veg and meat is the best choice. I love your documentary and I love this website, please continue to get the word out. I know I will.

    I’m afraid that doctor isn’t at all unusual. Pretty much everyone I know with “high” cholesterol has had statins pushed on them by doctors.

    Reply
  43. Sarah

    I found it mildly ironic that I had to go to this post to help me understand my blood test results… That you explained what the doctor didn’t/couldn’t. (I’ve been eating a basically ketogenic diet for the past 10 months–have lost 60+pounds, had all kinds of health problems clear up…)

    So on this blood test, there was expressed concern over my LDL, which was 147. No comment at all about my HDL or triglycerides, which were 73 and 55, respectively. I searched for a while to make sense of these numbers, then remembered from Fat Head you’d given a basic explanation, and hunted for this post. Helped a lot, thank you!

    Oh, and I loved this. My results state that I have “low blood glucose”… 64, one point below “normal range” of 65-99. I love that. One point below normal, and it’s “low”.

    Jimmy Moore’s new book (see review coming up later tonight) is the longer version of what you learned from this post.

    Reply

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