Very High Cholesterol

Diet and Nutrition
21

[quote]jsbrook wrote:
Cthulhu wrote:
pat7337 wrote:
I cannot add much to the discussion about the safety and efficacy of statins at preventing heart disease. I have, however, been on cholesterol medications for a long time, and can comment reasonably on the side effects of the drugs.

Un-medicated, my total cholesterol sits around 400 (This is very high). My HDL is typically low (~25). Therefor, I am twice screwed. My cholesterol is barely influenced by my diet and exercise- It is just genetically high.

Although you may guess from my 400 total that I am a very old man, I am in fact only 22 years old. I have been on a whole bunch of medications for cholesterol beginning with these awful “Cholly (sp?) bars” at age 4. I’ve also been on zetia, welchol, zocor, and vytorin (zocor and zetia), as well as various combinations of the above. I am currently on vytorin, which is a combination of zocor (a statin) and zetia.

I’ve been on vytorin for about 2 years. Side effects to date? None. No muscle pain/weakness, liver function is fine. My medicated cholesterol total is around 240. My HDL is still low.

My cardiologist is a terrific doctor. I have great trust in him. He has been studying cardiology his entire adult life, and is convinced that this medication will improve my long term health.

Ultimately, of course, I am responsible for my own health. But can I make a more educated decision based on reading a few articles that slander statins than I can by relying on the wisdom of my doctor and my conversations with him? I don’t think so.

I’ll add a little of my personal feelings here. As I said, I am 22 years old. I am going to have to be on drugs a really long time. That absolutely scares me. Can my liver survive 60 years of daily bombardment with drugs?

I am very fortunate to have a sister who is nearly a doctor (last year of medical school). When I relayed my fears to her she told me something like, "Yeah, taking statins everyday may affect your liver. However, the liver is the most resilient organ in the body, and can recover from significant damage. More importantly, liver function is checked whenever I get a blood test.

As long as I keep regular checks of my cholesterol and liver function (about every 6 months), I have virtually no chance of long term liver damage. Furthermore, by the time I get a bit older it is likely that new drugs will be developed that won’t affect the liver at all. However, if I don’t take the drugs it is pretty likely I will have heart problems."

Very unlikely liver damage or likely heart damage? This made the decision easy for me.

-Pat

I tried- unsuccessfully :slight_smile: -to keep this post short. If anyone wants more information about my experience or wants to discuss this further, or if you are a 20 year old kid who is worried about being on drugs your whole life, please don’t hesitate to PM me.

You’re only 22. You do not exactly know what the outcome may be. No doubt the liver is a resilient and can recover from significant damage, but I don’t think that a person who gets dignosed with liver failure after 60 of using statin drugs will be able to recover. If that were the case, alcoholics wouldn’t need liver transplants and wouldn’t die of liver failure.

Are you going to drop dead or develop heart or liver problems by using a statin over night? Probably not. How about for 50-60 years? Maybe. My question isn’t that people like you are using these drugs for short term use only, but for long term use also.

Is it your goal to be on cholesterol medication for two years, or even your whole life? Or do you eventually want to come off? You have to look at the big picture and ask yourself these questions.

I think you’re being extremely unrealisitic here. He no doubt should be taking plenty of fish oil and optimizing his cholesterol in every natural way possible. But that’s just not enough. Natural remedies just ain’t as efffective as medication.

For someone to such high LDL and low HDL, medication is a must. For life. The benefits [living] far outweigh the risks. That said, everyone who can control their cholesterol without medication should do so.[/quote]

I’m not talking about a few percentage of the population who is “genetically predisposed”-even those people who naturally have higher cholesterol levels doesn’t mean they’re going to get heart disease; nor does it mean they have to be taking cholesterol medications for life.
A high percentage of the population that does have extremely high cholesterol levels that is the average couch potato can easily lower their cholesterol through diet/lifestyle. Everyone who naturally has higher cholesterol levels doesn’t have to be popping statins for the rest of their life. That is unrealistic.

22

[quote]superscience wrote:
AllBizNiz wrote:
My dad has had near 300 cholesterol for as long as I remember, always stressed over it, and is currently a relatively health 74yr old. Thanks for reading this overly long post.

This is the main point i’m getting at;
HIGH CHOLESTEROL DOESN’T ALWAYS MEAN YOUR UNHEALTHY.
[/quote]

Exactly. Many people from around the world have high cholesterol levels and they’ve never had a history of heart disease in their lifetime or their family. There is no point to taking statins for life just because your cholesterol levels are naturally higher. People naturally had higher cholesterol levels 80 years ago when heart disease wasn’t at an epidemic level.

23

While I agree with what you’re saying, I am not saying that you shouldn’t take them for a short period of time. I just don’t believe taking statins for the rest of your life is healthy or necessary.

If someone who eats right, exercises daily, naturally has higher cholesterol levels and their doctor wants to put them on statins, then that is probably a good indicator that his cholesterol levels are naturally higher and it doesn’t mean he is going to get heart disease.

However, no matter how high your cholesterol levels are, there is a dangerous level for everyone and if nothing is working and they want to use statins, then they can go for it.

On my Dads side of my family, there is a history of them having high cholesterol levels. But no one in my family, or even my grandparents, has ever had a heart attack or had heart disease. In fact, my grand dads doctor was telling him that he needed to be on cholesterol medication or he’ll end up having heart problems. He also lived to the ripe old age of 98.

[quote]MODOK wrote:
There are other pharmacological options besides HMG CoA reductase inhibitors (statins). Fibrinic acid derivitives like Lopid and Tricor, niacin, and bile acid sequesterants (cholestyamine) are three good options if you are dead set against statins. The fear of statins I’ve seen in these posts is quite unwarranted though.

Statins are no more hepatotoxic than many other drugs. I’m all for non-pharmacological interventions to be exhausted first, but in the end drugs should definitely be used when hypercholesterolemia can’t be controlled by other measures.[/quote]

24

To Cthulhu:
I couldn’t agree more. I am only 22, and I have no idea what my outcome will be. It would be silly of me to claim otherwise. I would vastly prefer to have normal cholesterol levels and not have to deal with this decision, especially at such an early age. However, this is the reality of my situation, and I must make the most educated decision possible.

In my post above I was not trying to claim that everyone with high cholesterol should be on statins. As I said, I am not a doctor. If anyone starts taking statins on my advice, they may need to go see a psychologist =)

My post was intended primarily to state that I have been on statins a while and have had no ill effects. Also, I wanted to share my rational for taking the drugs.

As to the concerns about liver damage, yes, there may be potential long term problems. However, there are simple blood test that will detect liver problems well in advance. As long as I am diligent in getting liver function tested, I will know well in advance if I am do for trouble. I pray to God this situations does not arise! If I do end up in this situation I don’t know what I will do.

So am I exposing myself to potential liver trouble? Perhaps. On the weight of the evidence, however, I believe the significantly higher risk of heart disease justifies my use of the drugs.

Is it my “goal” to be on cholesterol medication for my whole life. No. My goal is to maximize my health and longevity. I will utilize medications if they help meet this goal. As for fish oil lowering my cholesterol- I take 10-15 grams of fish oil a day. It has had no measurable effect on my levels. However, I still believe that it may benefit my heart through other mechanisms, and will certainly continue to take it.

Height and weight? About 6 feet tall, 185lbs. My body fat is always under 10%. I do not have diabetes.

25

To jsbrooks:
Thanks for your post. I agree with your statements. Everyone who has high cholesterol should try to optimize there health naturally first.

To all:
If you are here at T-Nation and you don’t know diet and exercise affect your health, you have some serious problems! :slight_smile:

I realize I am an exceptional case. I am genetically predisposed to have really high cholesterol, and all the diet and exercise in the world will not lower it. So I’m stuck with drugs for now.

If you are a lazy couch potato, you should get your diet and exercise in order first! If your doctor does not recommend this, but rather says to take drugs right away, he or she is a poor doctor.

If you are unsure about the efficacy of the drugs on the prevention of mortality, I would suggest searching pubmed for “statins mortality” or something similar. Or better yet, talk to your cardiologist!

As one final comment, my old man has genetically high cholesterol too. He’s been on statins for a long time (near two decades). He has no complaints due to the drugs (Though he does get really bad flushing from Niacin).

If anyone on this thread is a medical doctor, I’d like to hear your thoughts.

26

Hi guys,
Several posters commented about studies showing that high cholesterol doesn’t effect mortality- ie people can live a long time with it and it is no big deal.

I’m not trying to be smart, but can anyone point me to a legitimate source of information about this? I have heard this anecdotally before, but never seen it anywhere legitimate. It seems possible that certain genetic groups could have higher levels and be fine, or that certain dietary patterns would negate the effects.

Anybody know a study where a culture of dude’s with 400+ total cholesterol live an average of 80 years? I’d love to read it.

Thanks,
Pat

[quote]Cthulhu wrote:
superscience wrote:
AllBizNiz wrote:
My dad has had near 300 cholesterol for as long as I remember, always stressed over it, and is currently a relatively health 74yr old. Thanks for reading this overly long post.

This is the main point i’m getting at;
HIGH CHOLESTEROL DOESN’T ALWAYS MEAN YOUR UNHEALTHY.

Exactly. Many people from around the world have high cholesterol levels and they’ve never had a history of heart disease in their lifetime or their family. There is no point to taking statins for life just because your cholesterol levels are naturally higher. People naturally had higher cholesterol levels 80 years ago when heart disease wasn’t at an epidemic level.[/quote]

27

[quote]Cthulhu wrote:
jsbrook wrote:
Cthulhu wrote:
pat7337 wrote:
I cannot add much to the discussion about the safety and efficacy of statins at preventing heart disease. I have, however, been on cholesterol medications for a long time, and can comment reasonably on the side effects of the drugs.

Un-medicated, my total cholesterol sits around 400 (This is very high). My HDL is typically low (~25). Therefor, I am twice screwed. My cholesterol is barely influenced by my diet and exercise- It is just genetically high.

Although you may guess from my 400 total that I am a very old man, I am in fact only 22 years old. I have been on a whole bunch of medications for cholesterol beginning with these awful “Cholly (sp?) bars” at age 4. I’ve also been on zetia, welchol, zocor, and vytorin (zocor and zetia), as well as various combinations of the above. I am currently on vytorin, which is a combination of zocor (a statin) and zetia.

I’ve been on vytorin for about 2 years. Side effects to date? None. No muscle pain/weakness, liver function is fine. My medicated cholesterol total is around 240. My HDL is still low.

My cardiologist is a terrific doctor. I have great trust in him. He has been studying cardiology his entire adult life, and is convinced that this medication will improve my long term health.

Ultimately, of course, I am responsible for my own health. But can I make a more educated decision based on reading a few articles that slander statins than I can by relying on the wisdom of my doctor and my conversations with him? I don’t think so.

I’ll add a little of my personal feelings here. As I said, I am 22 years old. I am going to have to be on drugs a really long time. That absolutely scares me. Can my liver survive 60 years of daily bombardment with drugs?

I am very fortunate to have a sister who is nearly a doctor (last year of medical school). When I relayed my fears to her she told me something like, "Yeah, taking statins everyday may affect your liver. However, the liver is the most resilient organ in the body, and can recover from significant damage. More importantly, liver function is checked whenever I get a blood test.

As long as I keep regular checks of my cholesterol and liver function (about every 6 months), I have virtually no chance of long term liver damage. Furthermore, by the time I get a bit older it is likely that new drugs will be developed that won’t affect the liver at all. However, if I don’t take the drugs it is pretty likely I will have heart problems."

Very unlikely liver damage or likely heart damage? This made the decision easy for me.

-Pat

I tried- unsuccessfully :slight_smile: -to keep this post short. If anyone wants more information about my experience or wants to discuss this further, or if you are a 20 year old kid who is worried about being on drugs your whole life, please don’t hesitate to PM me.

You’re only 22. You do not exactly know what the outcome may be. No doubt the liver is a resilient and can recover from significant damage, but I don’t think that a person who gets dignosed with liver failure after 60 of using statin drugs will be able to recover. If that were the case, alcoholics wouldn’t need liver transplants and wouldn’t die of liver failure.

Are you going to drop dead or develop heart or liver problems by using a statin over night? Probably not. How about for 50-60 years? Maybe. My question isn’t that people like you are using these drugs for short term use only, but for long term use also.

Is it your goal to be on cholesterol medication for two years, or even your whole life? Or do you eventually want to come off? You have to look at the big picture and ask yourself these questions.

I think you’re being extremely unrealisitic here. He no doubt should be taking plenty of fish oil and optimizing his cholesterol in every natural way possible. But that’s just not enough. Natural remedies just ain’t as efffective as medication.

For someone to such high LDL and low HDL, medication is a must. For life. The benefits [living] far outweigh the risks. That said, everyone who can control their cholesterol without medication should do so.

I’m not talking about a few percentage of the population who is “genetically predisposed”-even those people who naturally have higher cholesterol levels doesn’t mean they’re going to get heart disease; nor does it mean they have to be taking cholesterol medications for life.

A high percentage of the population that does have extremely high cholesterol levels that is the average couch potato can easily lower their cholesterol through diet/lifestyle. Everyone who naturally has higher cholesterol levels doesn’t have to be popping statins for the rest of their life. That is unrealistic.
[/quote]

I’m not talking about people with very high cholesterol from eating bad, processed food and sitting on the couch. I’m talking about an active 22 yr old who is a member of this forum who presumably has a handle on proper nutrition and still has an unmedicated LDL of 400. Such a person should be on medication. I already said that a healthy lifestyle is a must and every effort should be made to control cholesterol naturally.

28

Cholesterol is only one piece of the puzzle to controlling heart disease.

As is it was mentioned you could be young, physically active and have a normal cholesterol readings and still have heart disease.

You could also be genetically blessed and smoke, eat want you want, live an inactive lifestyle and live to be over 100 with a well functioning body and mind.

Then there is the rest of us somewhere in-between the above 2 extremes.

Inflammation is a risk factor for heart disease also

It certainly appears that there is no such thing as an HDL that is too high. The population that is genetically gifted with an HDL over 100 often are the ones I mentioned above that can often seem to do what they want, and live healthy to over 100. Right now drugs can not raise HDL very much or as effectively as they can lower LDL. Niacin seems to be about the best we have for HDL. Niacin is not without side affects also.

Curcumin, red wine, Statins, fruit juice and a million other things may have a slight effect on HDL also. I am sure there are drugs being developed right now that can raise HDL. Having a high HDL is not an entitlement to think you can live how you want and avoid the consequences of your lifestyle. Having a high HDL decreases risk of heart disease more than a high LDL increases your risk of heart disease. Doctors do not focus on HDL much though because it is much harder to alter. Oh yeah, you can raise HDL with female hormones too, and I am sure everyone on this site wants to take those.

Certainly you want to control cholesterol with lifestyle such as: lots of cardio, resistance training, low body fat percentage, control your blood pressure, control stress, and eat a healthy diet low in carbs, and low in bad fats and high in vegetables. Avoid smoking.

Back to LDL. LDL responds significantly for most people with lifestyle modifications. Fish oil can help some and is good for inflammation and triglycerides. The link for high LDL and heart disease is real. Your risk for heart disease is based on many factors and how high your LDL is just one of them. If my LDL was above 190 despite making lifestyle changes I do not think I could talk myself out of Statins. The more risk factors you have for heart disease the more aggressive you should be with your cholesterol control. People who have had a heart attack often try to keep their LDL below 100.

Supplements are fine to try also before drugs. The stronger supplements are very drug like and can also cause liver damage and other side affects. I think Statins should be a last resort, but for many, many people the benefit they offer is worth their risk. There are some doctors that believe Statins are so great people without risk factors should be taking them for prevention.

29

[quote]pat7337 wrote:
Hi guys,
Several posters commented about studies showing that high cholesterol doesn’t effect mortality- ie people can live a long time with it and it is no big deal.

I’m not trying to be smart, but can anyone point me to a legitimate source of information about this? I have heard this anecdotally before, but never seen it anywhere legitimate. It seems possible that certain genetic groups could have higher levels and be fine, or that certain dietary patterns would negate the effects.

Anybody know a study where a culture of dude’s with 400+ total cholesterol live an average of 80 years? I’d love to read it.

Thanks,
Pat

Cthulhu wrote:
superscience wrote:
AllBizNiz wrote:
My dad has had near 300 cholesterol for as long as I remember, always stressed over it, and is currently a relatively health 74yr old. Thanks for reading this overly long post.

This is the main point i’m getting at;
HIGH CHOLESTEROL DOESN’T ALWAYS MEAN YOUR UNHEALTHY.

Exactly. Many people from around the world have high cholesterol levels and they’ve never had a history of heart disease in their lifetime or their family. There is no point to taking statins for life just because your cholesterol levels are naturally higher. People naturally had higher cholesterol levels 80 years ago when heart disease wasn’t at an epidemic level.

[/quote]

Books have been referenced. My athens account doesn’t give me access to the main studies done on cholesterol.

Do not settle for the abstract, for example, one of the statin trials showed women were 13 times more at risk for breast cancer, yet reseacrhes did not include this in the listed side effects and the abstract.

30

It is not true either, that cholesterol has a strong power to predict the risk of a heart attack in men above 65. In the 30 year follow-up of the Framingham population for instance, high cholesterol was not predictive at all after the age of forty-seven, and those whose cholesterol went down had the highest risk of having a heart attack!

To cite the Framingham authors: "For each 1 mg/dl drop of cholesterol there was an 11 % increase in coronary and total mortality [Anderson KM, Castelli WP, Levy D. Cholesterol and mortality. 30 years of follow-up from the Framingham study. JAMA 1987;257:2176-2180].

It is not true either, that high cholesterol is a strong, independent predictor for other individuals.

In most studies of women and of patients who already have had a heart attack, high cholesterol has little predictive power, if any at all.

In a large study of Canadian men high cholesterol did not predict a heart attack, not even after 12 years, and in Russia, low, not high cholesterol level, is associated with future heart attacks (read summary of paper).

Most interesting is the fact, that in some families with the highest cholesterol levels ever seen in human beings, so-called familial hypercholesterolemia, the individuals do not get a heart attack more often than ordinary people, and they live just as long (read the paper and my comment).

Taken together such observations strongly suggest that high cholesterol is only a risk marker, a factor that is secondary to the real cause of coronary heart disease. It is just as logical to lower cholesterol to prevent a heart attack, as to lower an elevated body temperature to combat an underlying infection or cancer.

31

Im willing to bet that your insulin is being raised somewhere in your body.
Maybe from a medication your taking?
Maybe you got your bloodwork done on a mon after your weekend carb up? Pasquale has said repeated times that he sees a rise in tryglicerides and cholesterol on the carb ups.

It has been shown many times that cholesterol when way out of range is due to high insulin levels, not cholesterol itself.

I think your dizzy spells were because you weren’t fully adapted to the diet, Not taking extra potassium (which you should on a lcd) and defenitely get extra magnesium. Not to mention at least 6g of fish oil a day.

All of those things contribute.

32

It is interesting to note that the following comment on the fact that the drop of 1 mg/dl of cholesterol increases mortality has been taken out of context and that the authors conclusions were ignored.

Falling levels of cholesterol are a marker of mortality, not lower cholesterol in itself. And as it was mentionned by the authors falling levels of cholesterol were perhaps associated with diseases predisposing to death.

As to Familial Hypercholesterolemia, I don’t know where you take your information from but these people have one of the highest CAD-related deaths, in homozygous FH, death can occure as young as 1-2 years old with unlikely survival to adulthood. With heterozygous FH, symptoms develop by the 4th decade with CAD mortality 100 times higher than age-adjusted counterparts.

What always amazes me is that on every board there is a few guys who believe they have been able to find the Da Vinci Code of Cholesterol by reading a publicaly available world known study that noboby else in the history of cardiovascular research has been able to crack…that the cholesterol hypothesis is a fraud!!!

Come on…unless you’re an Albert Einstein simulacre that can pull out new theoretical concepts out of his hat, chances are that people much more experienced, devoted and intelligent than you (not the poster, the you in general) have actually thought about it and decided that the concept/theory is valid.

Then again, is fish oils where pushed by Big Pharma and supp companies where trying to push statins in the form of Red Yeast Rice, we’d have the same discussion but in reverse…fish oils are such a scam…and so on and so forth.

Sadly, this thread is just but a shawdow of a much more interesting thread maybe a year or two ago on cholesterol, we are kinda late to the debate.

AlexH.

[quote]superscience wrote:
It is not true either, that cholesterol has a strong power to predict the risk of a heart attack in men above 65. In the 30 year follow-up of the Framingham population for instance, high cholesterol was not predictive at all after the age of forty-seven, and those whose cholesterol went down had the highest risk of having a heart attack!

To cite the Framingham authors: "For each 1 mg/dl drop of cholesterol there was an 11 % increase in coronary and total mortality [Anderson KM, Castelli WP, Levy D. Cholesterol and mortality. 30 years of follow-up from the Framingham study. JAMA 1987;257:2176-2180].

It is not true either, that high cholesterol is a strong, independent predictor for other individuals.

In most studies of women and of patients who already have had a heart attack, high cholesterol has little predictive power, if any at all.

In a large study of Canadian men high cholesterol did not predict a heart attack, not even after 12 years, and in Russia, low, not high cholesterol level, is associated with future heart attacks (read summary of paper).

Most interesting is the fact, that in some families with the highest cholesterol levels ever seen in human beings, so-called familial hypercholesterolemia, the individuals do not get a heart attack more often than ordinary people, and they live just as long (read the paper and my comment).

Taken together such observations strongly suggest that high cholesterol is only a risk marker, a factor that is secondary to the real cause of coronary heart disease. It is just as logical to lower cholesterol to prevent a heart attack, as to lower an elevated body temperature to combat an underlying infection or cancer. [/quote]

33

The sad thing about most manipulated unsupportive cholesterol and CHD studies is, they chose people with the disease, studies for the general population should be done on the general population without the familial disease.

34

This is taken from www.thincs.org

Eddie Vos

Bonjour J…,
Not happy news for Pravachol: in high risk for “vascular disease” [24% of the assessed population] men/women, mean age 75, n=2891 on drug, 3.2 years later overall SURVIVAL in statin group: 89.7%, vs. 89.7% in placebo. My guess: ~$9m/US in drug cost alone to find only 8 fewer deaths, and significantly more cancer. From reading the abstract, one would never guess the outcome since mortality is not mentioned. The “combined endpoint” masked other effects, including harm in other areas of health.

In this study LDL was lowered by 34%. This study joins most other statin studies that are all of short duration. 25% more new diagnosis of cancer in statin group. There was no assessment if “patients” liked the overall effect of the drug vs. placebo, e.g. muscle pain, etc. Unfortunately this is, in my reading of the studies, the general trend for statins.

35

There is also a good number of studies which report protection against cancer such as colorectal and prostate cancer. However, meta-analyses with all their pros and cons, have yet to find any conclusive evidence that statins affect cancer risk as a whole.

[quote]superscience wrote:
This is taken from www.thincs.org

Eddie Vos

Bonjour J…,
Not happy news for Pravachol: in high risk for “vascular disease” [24% of the assessed population] men/women, mean age 75, n=2891 on drug, 3.2 years later overall SURVIVAL in statin group: 89.7%, vs. 89.7% in placebo. My guess: ~$9m/US in drug cost alone to find only 8 fewer deaths, and significantly more cancer. From reading the abstract, one would never guess the outcome since mortality is not mentioned. The “combined endpoint” masked other effects, including harm in other areas of health.

In this study LDL was lowered by 34%. This study joins most other statin studies that are all of short duration. 25% more new diagnosis of cancer in statin group. There was no assessment if “patients” liked the overall effect of the drug vs. placebo, e.g. muscle pain, etc. Unfortunately this is, in my reading of the studies, the general trend for statins.[/quote]