LDL at 357 ng/dl, young, lean athlete on Paleo 7 years page 4

[yodiewan]

Does anyone know if there are differences in treatment approach to extremely high cholesterol that is non-FH, and FH? Or between the different FH subtypes?

If your cholesterol is high due to hypothyroidism, the treatment is different. Your docotor will probably prescribe Synthroid or Armour thyroid. I am not very knowledgeble about the different medications, but I think those are the two most popular ones.

Interestingly, the mechanism that causes LDL to go down with proper treatment is the same with both thyroid and statins (at least from what I understand). It's the upregulation of the LDL receptor on your cells.

Statins cause a cholesterol deficiency in your cells by interrupting their process for producing cholesterol locally, which makes them express the LDL receptor to get more out of the blood. This also causes all the terrible side effects that many people experience like myalgia, rhabdomyolysis, and cognitive problems. Reading this makes me NEVER want to take statins: How Statins Really Work Explains Why They Don't Really Work.

I am not sure about the mechanism, but raising T3 if it is low causes increased expression of the LDL receptor also, without first causing a cholesterol defeciency in the cell since it's not breaking the cholesterol synthesis pathway.

If it does happen to be thyroid related, Chris Kresser has several excellent posts on the subject of thyroid health.

[jel]

I also have FH; last NMR test showed LDL around 400. It's funny that so many people on this forum read a little about cholesterol and statins, and then think they are experts on all cholesterol issues, especially FH - we're a completely different case. Peter Attia at eatingacademy.com (down at the moment) recently did a series on cholesterol, and his main point is that particle number is the driving force of cholesterol-related heart disease. People with FH usually have high LDL, and high particle count (large and fluffy particles, but many of them). He replied to a comment of mine on his site stating that FH absolutely requires statins. If, like me, you have FH, statins were made for us. The drug industry has just been successful in its pursuit of selling statins to everyone. I haven't started taking them yet, but I have decided that I will eventually, unless someone shows me proof otherwise.

Edit: Let me add that I've seen numerous cases around the internet of people who think they have FH, but make dietary changes to lower their cholesterol to a more reasonable number. Eating more carbs, more iodine, and less dairy fat are some things you can try. However, these reports always report lowering LDL-C, not LDL-P, so I can't be sure that they are reducing risk.

[yodiewan]

Thanks, jel. I'm currently trying the dietary interventions you mentioned (more carbs, more iodine) since I don't know if I have FH or not. I did get NMR done and have a high particle number (over 2000). My doctor prescribed a statin (Crestor/rosuvastatin), but I haven't gotten the prescription filled. I asked for a full thyroid panel first to rule out hypothyroidism, but they only tested TSH and T4.

Are you worried about the side effects of statins? Won't they still cause depletion of CoQ10 (yeah supplmentation could help, but it still seems like an issue)? Just curious about your thoughts.

[jel]

I am worried about taking statins. But I think I am more terrified of leaving my wife and kids behind at age 50 or earlier. I've read enough about statins to understand the side effects, and the debate on their efficacy. When I'm looking at a particle count near 3000 and LDL-C of 400, I think the side effects may be worth it if I can live longer.

For now, I am focusing on diet, exercise, and stress management. However, I do not dismiss the idea of taking statins like I once did. Of course I hate the fact that I may have to take them, but I am keeping an open mind.

[Knifegill]

What about a diet that is very heavy in all the foods said to remove cholesterol from the bloodstream?