T Nation

Cholesterol Levels

what are yours like? I’m elevated and I’m weighing my options.

results mmol/L followed by mg/dL
CHOL 7.24 279
LDL 5.46 210
HDL 1.37 53
CHOL/HDL 5.3 (ratio)

so i`m going to figure out what I want to do, first reaction from the doc was to test again, and will want me on pills if it is the same.

this is all new to me…never really thought about it before this test…

His first recommendation should have been diet. But yeah, your LDL-C is really, really high and there’s a good chance you end up on one of the potent statins (Lipitor or Crestor). Your HDL is normal. Total-C’s pretty meaningless.

What’s your diet like?

5/3/1 has a great affect on your cholesterol, while simultaneously insuring that you are not killed and eaten.

1-2 weeks of strict Atkins will bring your numbers in line tout-de-suite, but only if you do 5/3/1.

my diet is typical bodybuilder who eats a lot of beef, eggs, good carbs with bad ones sometimes also. If i cook in oil it is the “good kind”.

Areas I have identified for diet:
I could increase fibre, more fish oil, less refined carbs, more nuts. Don’t really want to reduce the rest though, only add…

does low card really reduce LDL? i’ll have to read up on that…

You should take CoQ10 supplements with statin drugs, as the statin drugs reduce your CoQ10 production.

Will insurance pay or out of pocket? Generics are cheap, perhaps $40 per year.

Often C levels go up in response to falling T levels. DHEA might be useful, but its classified as a drug. It used to be on the shelf in vitamin shops until 1996.

Your age would have been useful.

Is your fasting serum glucose OK?

[quote]KSman wrote:
You should take CoQ10 supplements with statin drugs, as the statin drugs reduce your CoQ10 production.

Will insurance pay or out of pocket? Generics are cheap, perhaps $40 per year.

Often C levels go up in response to falling T levels. DHEA might be useful, but its classified as a drug. It used to be on the shelf in vitamin shops until 1996.

Your age would have been useful.

Is your fasting serum glucose OK?[/quote]

Yes i have insurance to cover it.

My age is 36, this is part of my reluctance to go on a pill, I’ll be on it for the rest of my life…in my brain there is a concern that there will be some long term side effect, even worse a slowly appearing one so i don’t make the connection. Perhaps I am over cautious. The whole quality of life vs. quantity of life debate.

Fasting glucose was fine.

The other issue in my brain is that there still seems to be some controversy about cholesterol, not everyone is convinced it is a cause of anything.

[quote]Rek wrote:
my diet is typical bodybuilder who eats a lot of beef, eggs, good carbs with bad ones sometimes also. If i cook in oil it is the “good kind”.

Areas I have identified for diet:
I could increase fibre, more fish oil, less refined carbs, more nuts. Don’t really want to reduce the rest though, only add…

does low card really reduce LDL? i’ll have to read up on that…
[/quote]

it brought all my cholesterol numbers in line in less than 2 weeks. quit eating anything made from powdered white stuff (sugar, flour, crack). eat meat and green veggies. make sure you are getting min 1g protein per pound bodyweight. try it. 2 weeks strict, then have your cholesterol checked.

Statin drugs can can push total cholesterol too low. Some drug companies are telling docs to seek levels that are actually harmful. A number of 180 might be ideal. If cholesterol gets to low, hormones can be messed up and you might feel like crap. Drugs reps have started to push a protocol of 80mg Lipitor.

Statin drug doses that are too high also make CoQ10 problems more severe. You need to read about CoQ10 and mitochondrial function to understand the perils. You will have to pay for CoQ10 supplements on your own. The costs of taking too large of a statin dose need to also take into account the costs of larger CoQ10 doses. To really know if one is taking enough CoQ10, one would also do some lab tests for CoQ10 that can cost $100-$200 http://www.lef.org/Vitamins-Supplements/ItemLC120251/CoQ10-Coenzyme-Q10-Blood-Test.html. Insurance may not pay for testing that relates to supplement use.

Low CoQ10 slows down ones metabolism, which can reduce vitality and lead to fat gain. Gaining fat makes lipids worse and then you need a larger statin dose, further reducing mitochondrial function.

Some insurance plans may insist that you use a generic drug and may make you pay for brand name drugs.

[quote]KSman wrote:
Statin drugs can can push total cholesterol too low…Drugs reps have started to push a protocol of 80mg Lipitor…Statin drug doses that are too high also make CoQ10 problems more severe…Low CoQ10 slows down ones metabolism, which can reduce vitality and lead to fat gain. Gaining fat makes lipids worse and then you need a larger statin dose, further reducing mitochondrial function.

[/quote]

and that is why i have a hard time swallowing pills until I’ve tried all I can do on my own so I know i have no choice but to go that route. I need to see my diet changes fail I guess.

Until now I didn’t read much about this, so I’ve started now, thanks for all the pointers on areas to investigate.

I take 10mg lovastatin as that is cheaper than getting the same chemical in red rice yeast extract. This cost me $20 per year.

[quote]Rek wrote:
what are yours like? I’m elevated and I’m weighing my options.

results mmol/L followed by mg/dL
CHOL 7.24 279
LDL 5.46 210
HDL 1.37 53
CHOL/HDL 5.3 (ratio)

so i`m going to figure out what I want to do, first reaction from the doc was to test again, and will want me on pills if it is the same.

this is all new to me…never really thought about it before this test…
[/quote]

who cares about cholesterol? is your BP normal, sugar normal, weight normal, triglycerides normal, you don’t smoke??? i’d do some more cardio and take some fish oil and sleep like a baby with those numbers.

[quote]thruxton45 wrote:

[quote]Rek wrote:
what are yours like? I’m elevated and I’m weighing my options.

results mmol/L followed by mg/dL
CHOL 7.24 279
LDL 5.46 210
HDL 1.37 53
CHOL/HDL 5.3 (ratio)

so i`m going to figure out what I want to do, first reaction from the doc was to test again, and will want me on pills if it is the same.

this is all new to me…never really thought about it before this test…
[/quote]

who cares about cholesterol? is your BP normal, sugar normal, weight normal, triglycerides normal, you don’t smoke??? i’d do some more cardio and take some fish oil and sleep like a baby with those numbers.

[/quote]

all normal and no i don’t smoke.

who cares about cholesterol? well that’s the piece i’m still trying to figure out. Because i think i don’t care, but i want to make sure i don’t care.

There’s a lot of interesting arguments that cholesterol has nothing to do with heart disease. You might look into some of them and decide for yourself. Here’s a decent starting point.

BTW, this Dr. Dach does the Crisler TRT protocol for a couple people on this board.

You should care.

Here’s the deal: the link between dietary cholesterol and lipid levels in the blood is not clear. But it’s very clear that blood LDL levels are highly predictive of stroke/heart attack risk, atherosclerosis, progression of atherosclerosis, etc. (The real bad guy is probably a kind of LDL called ApoB). The levels you have are VERY high and dangerous in the long term.

It’s recently been clearly established that lowering LDL levels sufficiently will lead to regression of atherosclerosis – it will shrink the plaques. Plagues lead to narrowing arteries and heart attacks and strokes.

The data also show that there’s really no lowest optimal level. Lower is pretty much better for LDL.

Statins are very safe and they’re very effective. The benefits vastly outweigh the risks. You’d be a fool not to take one if your LDL doesn’t get to a normal level with diet.

Have you had your cholesterol checked in the past? There are certain genetic conditions that lead to high cholesterol.

[quote]Res Judicata wrote:

Statins are very safe and they’re very effective. The benefits vastly outweigh the risks. You’d be a fool not to take one if your LDL doesn’t get to a normal level with diet.

[/quote]

This is often not true. Statins can cause low CoQ10 levels, mitochondrial dysfunction and heart muscle weakness that can lead to congestive heart failure. CoQ10 supplements are needed. If cholesterol goes too low, there can be lots of problems. That is really an issue of getting dosing right.

[quote]KSman wrote:

[quote]Res Judicata wrote:

Statins are very safe and they’re very effective. The benefits vastly outweigh the risks. You’d be a fool not to take one if your LDL doesn’t get to a normal level with diet.

[/quote]

This is often not true. Statins can cause low CoQ10 levels, mitochondrial dysfunction and heart muscle weakness that can lead to congestive heart failure. CoQ10 supplements are needed. If cholesterol goes too low, there can be lots of problems. That is really an issue of getting dosing right.[/quote]

These are very rare side effects if they even exist. There’s some alt-medicine chatter about causing heart failure, but there’s no proof at all from the studies. You would have expected to see it in the very large clinical trials with statins if it were a real risk. There is some legitimate concern that statins may worsen heart failure, but that’s an entirely separate issue.

The CoQ10/mitochondria thing has been brought up but there’s [edit] NO [/edit] convincing evidence that supplementation is needed or even useful. As of a couple of years ago, there were only a couple of small trials with inconsistent results. http://www.theheart.org/article/794465.do Still, it probably doesn’t do any harm. But “needed” is a very long stretch.

Some people used to believe, based on longitudinal studies, that very low cholesterol increase risk of, e.g., death. But that turned out to be because sickness can cause very low cholesterol. I’m not familiar with any causal evidence.

I posted this earlier in a different thread:

I disagree with the suggestion that cholesterol lowering drugs would be of unqualified benefit, as statin drugs can easily reduce CoQ10 levels, lowering mitochondrial activity which can simply replace heart attack events with death by congestive heart failure. CoQ10 supplements are needed with statin drugs. I need to tell a story: An older friend had a ongoing nagging cough. I asked if he was taking Lipitor. He responded, surprised that I asked, that he was on 40mg, [a large dose]. I gave him a bottle of 100mg ubiquinol CoQ10. His cough is gone and he has lost 17 pounds, a long term sore elbow is also “healed” [cannot explain that]. As he burns off his own fat, he eats less. 17 pound of fat is a lot of calories. He continues to loose fat. I notice that his blue jeans all look new too. [Constant coughing is a major symptom of congestive heart failure. A weakness in the heart causes back pressure in the lungs forcing fluids to accumulate in the lungs.]

How can you say that “There is some legitimate concern that statins may worsen heart failure, but that’s an entirely separate issue.”

Hey doc I have congestive heart failure. [Doc replies] “but that’s an entirely separate issue.”

These things are not rare for those affected. Why do you even want to start playing down the fact that statin drugs lower CoQ10? I know why drug reps would want to do that. What is wrong with advising people to take some CoQ10 to avoid a therapy induced CoQ10 deficiency? If you have to sell a negative aspect of statin drugs, then that is the way that it should be.

[quote]yorik wrote:
There’s a lot of interesting arguments that cholesterol has nothing to do with heart disease. You might look into some of them and decide for yourself. Here’s a decent starting point.

BTW, this Dr. Dach does the Crisler TRT protocol for a couple people on this board.
[/quote]

interesting site. Especially about women and statins.

[quote]KSman wrote:
I posted this earlier in a different thread:

I disagree with the suggestion that cholesterol lowering drugs would be of unqualified benefit, as statin drugs can easily reduce CoQ10 levels, lowering mitochondrial activity which can simply replace heart attack events with death by congestive heart failure. CoQ10 supplements are needed with statin drugs. I need to tell a story: An older friend had a ongoing nagging cough. I asked if he was taking Lipitor. He responded, surprised that I asked, that he was on 40mg, [a large dose]. I gave him a bottle of 100mg ubiquinol CoQ10. His cough is gone and he has lost 17 pounds, a long term sore elbow is also “healed” [cannot explain that]. As he burns off his own fat, he eats less. 17 pound of fat is a lot of calories. He continues to loose fat. I notice that his blue jeans all look new too. [Constant coughing is a major symptom of congestive heart failure. A weakness in the heart causes back pressure in the lungs forcing fluids to accumulate in the lungs.]

How can you say that “There is some legitimate concern that statins may worsen heart failure, but that’s an entirely separate issue.”

Hey doc I have congestive heart failure. [Doc replies] “but that’s an entirely separate issue.”

These things are not rare for those affected. Why do you even want to start playing down the fact that statin drugs lower CoQ10? I know why drug reps would want to do that. What is wrong with advising people to take some CoQ10 to avoid a therapy induced CoQ10 deficiency? If you have to sell a negative aspect of statin drugs, then that is the way that it should be.

[/quote]

Why do you people send the OP to quack pseudoscience? He’s a very high risk patient. Do you want him to die from a heart attack at 45? His LDL is literally in the very highest category and the very highest risk. High cholesterol is an exceptionally well established cause of atherosclerosis and risk factor for stroke and heart attack. There’s literally more than 40 years of evidence on this point. (Look up the Framingham heart study). There’s almost as much evidence that lowering LDL lowers risk for heart attack and stroke, and, if you lower LDL enough, you can get regression of atherosclerosis. The good news is that he doesn’t have any other risk factors – yet. (Unless he had near relatives die from a heart attack or stroke at a young age).

Heart failure and coronary artery disease different diseases. Statins are NOT INDICATED for patients with heart failure. CHF patients were excluded from most statin studies. So no one actually knows what the effect of statins are in that patient population. That’s why we do research. As of a few years ago there were a couple of large studies pending.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1551909/ I’m not sure of the results of that research. Now, if a doctor has a patient with elevated cholesterol and heart failure, he has some choices to make based on the limited data available and the drug options.

Statins almost certainly don’t cause heart failure, but they may worsen it in people who already have it. Or not. The evidence is up in the air.

You don’t get how drugs are regulated. Unless it’s on the label approved by the FDA, the drug reps basically can’t talk about it. It’s more complicated than that, but that’s the gist. The FDA fines the crap out of companies for off label claims. And, as I showed you, there’s no conclusive evidence CoQ10 supplementation is necessary or even helpful. There are two studies and they have inconclusive results. The drug reps (or even the drug companies) can’t say oh, by the way, you should take CoQ10 with this. Not without facing penalties. That’s up to the FDA and what’s in the FDA approved label.

And don’t give me one-off anecdotal evidence. That means jack shit. Show me a clinical trial.

Give me a break. You sure know how to sing a drug rep’s song.