Hey it's me again. I just got home from my diabetes check up and need help figuring some things out. First of all, my hA1c was 5.5-- drug free (fantastic, yay, happy dance). However, my cholesterol was WORSE than last visit (and it was not pretty at all last visit). I've been so good the last few months. I've cut the fat off of anything that's not grass fed (well except bacon, but I think I personally eat 2 packs of Coleman uncured bacon a month), upped my consumption of all things coconut, thoroughly enjoyed avocados, and EVOO. I've figured out that sugar has a very negative impact on my hormones and sends me into manic depressive rages, so I've done almost no baking all summer (unless you count homemade ice cream & haupia baking-- both made with stevia), and I've also figured out which nightshades irritate my body. I know, not much to do with cholesterol, but WTH AM I DOING WRONG?! I feel like Primal has finally *clicked* for me, and yet my cholesterol is getting worse. I REALLY don't want to go back to eating CW, cuz that will jack up my blood sugar, and I just got that under control... as good as peanut butter & banana on hot toast sounds (pretty good to me)
Doc was really upset and insisting I go on statins. Not angry upset, but more like "my-pet-is-sick-and-I-must-save-it!" upset.
My results (result followed by flag range):
CHOLESTEROL: 247 (100-199)
TRIGLYCERIDE: 160 (48-149)-- she did say my Trigs improved
HDL CHOLESTEROL: 37 (40-59)
CHOLESTEROL/HDL RATIO: 6.7 (0-3.1)
LDL: 178 (0-130)
LD/HDL RATIO: 4.8 (0-130)
VLDL: 32 (0-50
VITAMIN D: 77 (32-100)
I take daily:
800mg magnesium citrate
Six 2000mg Fish Oil capsules with 600mg Omega 3, 360 mg EPA & 240 mg DHA
2 Vitamin D3 500 IU
4 Diabet-X blood sugar supplements (containing chromium, cinnamon extract, gymnema silvestre extract, alpha lipoic acid, bilberry mirtoselect)
I can't go on statins, b/c hubby & I are TTC baby #2, so I would like to find a way to decrease cholesterol naturally while staying primal.
Oh, daily ratios average out around 60% fat, 25% protein, and up to 10% carbs (I try to stay in the 20g range on carbs)
Excellent job on your A1C!
If I recall correctly, your target LDL, with diabetes would be actually be under 100. My last test put me at 116, and my doctor said that I would not be able to get there without statins (after dropping from 158 in 3 months). Motivated me to prove him wrong... (He says things like "you can't do that without medicine" a lot... I think he does it on purpose because he figured out it motivates me).
At 178 LDL and 37 HDL, I do think it needs to be addressed.
Your lowering trigs are encouraging, as I would usually expect your chloesterol to follow your trigs. Low trigs... High LDL... expect your LDL to be coming down. High trigs... Low LDL... expect your LDL to be going up.
But, your trigs are a little on the high side considering your excellent A1C numbers.
With those numbers and understandable desire to avoid statins, you might want to consider a coronary calcium scan. This way we are looking directly at the heart for calcified plaque, instead of indirectly trying to extrapulate the risks by looking at chloesterol numbers.
These results may give you more guidance on balancing the statins with your TTC efforts. Clean heart... continue what you are doing, and see what happens.
Another thing to look into would be niacin. It has been show to be very effective on raising your HDL, and helps with trigs and LDL as well. But I am clueless on the compatibility of TTC.
You don't say what your numbers were last time or how long it has been between tests. You did say your trigs improved. That's one step in the right direction. I imagine with your A1C being 5.5 that the trigs will continue to come down. Your HDL is low - you could try some high dose niacin to bring that up.
That being said, various cholesterol profiles are associated with heart disease more than others. Many think that cholesterol profiles are markers of metabolic derangement and/or inflammation, which are the true causes of heart disease. Treating the cholesterol numbers does nothing to treat the underlying problem. Just as taking insulin does not "cure' diabetes. It took while to get your blood sugar down to normal levels by eating primal/low carb. Perhaps it will take a little longer to get the cholesterol numbers to look better.
In the meantime, it is highly unlikely that you are about the keel over from a heart attack. Regarding statins, there is NO EVIDENCE that taking statins lowers heart attack risk for WOMEN. Statins lower LDL, but do not raise HDL or lower trigs. I think you need to be more concerned about the trigs and HDL than the LDL and STATINS DO NOT IMPROVE those numbers. Please read this article about how/why cholesterol does not cause heart disease.
Why Cholesterol May Not Be the Cause Of Heart Disease
This my favorite article on the subject written by an MD. In it he makes the case that high INSULIN levels help contribute to heart disease, not just high blood sugar. So perhaps while your blood sugar is back down to normal, with your history of insulin resistance, your insulin levels may still be elevated. You might ask for a fasting insulin level as well as BS level next time you get tested. But hopefully with continued good diet this will continue to improve.
High levels of inflammation are a culprit in this as well. A CRP test will show your general level of bodily inflammatiion. If that number is normal, you really don't have much to worry about. I would definitely ask for that to be done as well.
Lastly, if your numbers did not improve with cutting way back on saturated animal fat, perhaps you could ease up on that limitation a bit.
FYI, fish oil is known to raise LDL in many people, though I'm not sure the cause is fully understood. Some will say it's merely an artifact of the way LDL is calculated -- that your lower triglyceride concentration results in a higher apparent (but not actual) LDL calculation.
Anecdotally I can say that a diabetic relative of mine started taking fish oil (far, FAR less than what you're taking) and saw his LDL numbers go up beyond the 100 threshold now used for diabetics as a risk factor. Whether or not that threshold is bogus, the doctor was all gloom and doom and strongly recommended statins. The patient resisted, and the doctor agreed to try the blood test again in a couple months to allow for some "diet and lifestyle changes". He took fish oil out of the diet, ate some oatmeal, and the LDL dropped ~ 25 points at the next blood test. Sure, there could be other factors at play here, but I thought you might find that interesting. If nothing else, maybe you could follow a similar strategy to get the doctor off your back while you figure out what's going on.
I'd be a little concerned about the lowish HDL and highish triglycerides, as they lead to some less than desirable ratios. I'm certain I've read studies about the connection between insulin levels, insulin resistance, and HDL metabolism, but I can't remember the details; you might want to research this. In your case, your diabetes combined with a ketogenic diet could be a double-whammy that causes problems with HDL.
Ok, I went back and looked at your previous results. Here's the before/after:
Your total cholesterol decreased very slightly (one might say insignificantly). HDL decreased substantially (not so great), triglycerides decreased a good amount (great!...and a predictable outcome of taking fish oil), LDL increased slightly (fish oil perhaps?), and VLDL went down a bit (no idea of the significance of this).
Overall I think it's positive that your triglycerides decreased, an unfortunate thing that your HDL decreased, and I feel indifferent about the change in your TC and LDL numbers. I don't know the details of your medical history, but I'd certainly give your body some time to heal itself before panicking and making a bunch of new changes. The only thing I'd change right now is to stop taking 12g of fish oil a day. Sometimes more is not better!