Hi, Everyone. I'm a new member to these boards.

I visited a doctor last week for the first time in 20+ years. I was going in for a "consultation," but ended up having blood drawn. I was NOT asked to fast beforehand, and I'd been on a modified low-carb diet for the previous six weeks. A few hours before the exam, I ate a breakfast of three eggs (scrambled in butter) and a small steak. Here are the lipid panel results:

Cholesterol Total: 347
HDL: 60
Chol./HDL: 5.8
LDL (Calculated): 255
Triglycerides: 160

I wasn't aware of the fasting protocol until I brought the test results home and saw "FASTING" in the comments field. I immediately phoned the doctor, who explained that fasting wouldn't have made a difference. (?!?!)

I don't believe that fasting would have lowered the cholesterol total, but I'm pretty sure that the triglycerides (and maybe the LDL?) would have come down.

I'm male, 52yrs, 5ft 6in, 130lb, Blood pressure 120/80, history of CHD and high blood pressure in my family (father and brother), non-smoker, no formal exercise routine, no meds (not even aspirin for a headache), and I almost never get seriously ill. (I had the flu once about 15yrs ago. Other than that, and occasional cold.)

Maybe not related, but a urinalysis also revealed traces of blood (1+) and protein. Ketone count was 80(3+). Also, I had started light weight training the day before.

I truly regret not going for these tests BEFORE I went low-carb in early December. My 48 year old brother had his heart attack in July, and since then I've read, among other things, Ravnskov's "The Cholesterol Myths" and Taubes's "Good Calories, Bad Calories." I was a vegetarian through most of my 20's, tried (and failed) Ornish's diet in my 40's, and now I'm pretty convinced that some sort of lower-carb diet is the way to go for heart health DESPITE my numbers.

The doctor wanted to write a prescription immediately, but I'm the only person within my family/friends circle who is NOT on any medications, and I'm not impressed with the results of their various pharmaceutical adventures. I want to stay drug free.

Even though I don't consider these non-fasting results a relevant base-line, I DO consider them a wakeup call. As of now, I plan on going to another doctor and having a *true* fasting lipid panel done. I've begun exercising, alternating weight-training and aerobics. I'm also going to accurately track how much protein/fat/carbs I'm ingesting every day.

Am I doing enough? Should I be flipping out over my numbers? Should I wait until I've been exercising for a month or so before I test again? Should I get a stress test? Are there any low-carbers out there who can relate to any of this?

Any answers, comments and advice would be appreciated. Thanks.

MrOK

Yeah ... I can relate to that. I am 51 years old, a type 1 diabetic, and doctors are forever bugging me to reduce cholesterol. I have also gone the low-carb route. And, having read what people like Mary Enig, Ravnskov, Taubes and Malcolm Kendrik have to say about it, I am not convinced that cholesterol causes heart disease. I am fortunate in that I don't have a family history of heart disease. But diabetes is considered CHD risk equivalent. And we have to at least try and look at things the way our esteemed doctors see them.

Your HDL is nice and high, probably because of the low carb diet. Exercise will probably increase it further. Your triglycerides would most probably have been a lot lower if you hadn't eaten beforehand. While The LDL is higher than normal, it could also have been increased by the meal. But don't over react to it. Have a fasting test done, persevere with the low-carb diet, and have another test done in 6 months. You will probably see an improvement in the numbers. You can have other tests done to see if there is in fact evidence of heart disease, like CRP, homocysteine and a heart scan.

Like you, I believe that drugs, of all kinds, should be avoided if at all possible.

Hi, Everyone. I'm a new member to these boards.

I visited a doctor last week for the first time in 20+ years. I was going in for a "consultation," but ended up having blood drawn. I was NOT asked to fast beforehand, and I'd been on a modified low-carb diet for the previous six weeks. A few hours before the exam, I ate a breakfast of three eggs (scrambled in butter) and a small steak. Here are the lipid panel results:

Cholesterol Total: 347
HDL: 60
Chol./HDL: 5.8
LDL (Calculated): 255
Triglycerides: 160

MrOK

I'm not sure if fasting affects ldl/hdl numbers much or not, but for triglycerides I was told that fasting matters. Ask for a lipoprotein test, which will show particle sizes, and also ask for a c-reactive protein and homocysteine test, and go from there.

If your LDL is actually 255 via a VAP/NMR test, and primarily small particles, I'd go the medication route, and also consider dietary changes. Low-carb is good, but replacing carbs with saturated fats might not be the best.

Fasting will have an impact on all your numbers exept possibly the HDL. Your doctor most likely feels that your results will still be high based off of these reading. I would tend to agree that fasting will not make a radical difference with the LDL.

namelessme
If your LDL is actually 255 via a VAP/NMR test, and primarily small particles, I'd go the medication route, and also consider dietary changes. Low-carb is good, but replacing carbs with saturated fats might not be the best.

IMO namelessme brings up a very important point. Get a lipoprotein (VAP or NMR test) and LP(a) test!!!!! You will have to do a little reseach to know how to interpit the information provided by these tests. (Don't count on your doctor knowing) But with their added information you will be better able to assess your risk and develop proper treatment stratagies. Let's hope the majority of those LDL particles are of the large variety. If so then things really are not all that bad.

Atkins mostly helps raise your HDL and doesn't really help your LDL. However, it helps your Tri-G's.

But Atkins will not adversly affect your blood test... even on a full stomach... as your cholesterol is very high. It would take a lot to skew your LDL numbers significantly.

I was diagnosed with high cholesterol 16 years ago at age 32, so my experiences to approaches at lowering it is many.

9 month Vegan diet caused my cholesterol to skyrocket... my worst results for any diet only remedy.

1 year Atkins diet with good weight loss, and daily exercise, gave me my best test results for a diet only approach.

Normal diet without exercise was still way better than the vegan diet.

But in all, my cholesterol numbers were still way far from where they should be by adjusting diets and exercise.

I've tried three different statins... none of which were able to bring my cholesterol levels down into normal range. Baychol did the best job by far... but was pulled off the market because it was killing people.

For the last 1.5 years, I've been taking Niaspan and it brought my numbers down 50%... into the normal range. The only medication to ever do this, and the side effects are minimal. Niaspan is just prescription niacin.

Bottom line, given your numbers, I do not think Atkins did not hurt your blood test.

Talk to your Doctor about trying Niaspan. Make sure you talk to him about the flushing it can cause.

I'm male, 52yrs, 5ft 6in, 130lb, Blood pressure 120/80, history of CHD and high blood pressure in my family (father and brother), non-smoker, no formal exercise routine, no meds (not even aspirin for a headache), and I almost never get seriously ill. (I had the flu once about 15yrs ago. Other than that, and occasional cold.)



There are a lot of excellent comments in response to your post. Following would be my opinion. Your height, weight and BP are positive. The canary in the mine shaft for you though are the lipid levels and familial CHD.

I just re-read an article written on the 20th anniversary of the death of Jim Fixx (Complete book of running) and some Dr's commented that they would have put him on a statin, given his cholesterol level and family history, despite excellent treadmill results and an overall picture of good health.

Another thread on this board is discussing the efficacy of statins and it is worth reading because, while the overall benefits of statins to society might be exaggerated, there are interesting results within various study groups. One of those is that statins reduced the number of heart attacks at the same rate in people without elevated cholesterol.

If you had no family history of CHD your Dr. might first suggest some further modification of your diet and a continued exercise regimen, then monitor you in another 90 days. But, given your family history, it might be wiser to take a look inside your arteries and establish their condition.

Here are some #'s from my recent experience (I went to the Dr. because of elevated BP).

Age: 55, Ht: 6.02 Weight 274

10/29/2007

TriG: 262
Total Ch: 270
HDL: 37
LDL: 181

12/10/2007 - Weight: 248

TriG: 117
Total Ch: 164
HDL: 39
LDL: 102

I was prescribed 40 MG of Pravachol when my first results were available but I had also embarked on a major dietary change which virtually eliminated refined carbs and upped my exercise regimen. The dr. suggested that diet, exercise and weight loss were responsible for the majority of the change with the exception of the LDL which was most influenced by the statin.

My hope is to continue weight loss and drop the statin because while the side effects are not major at the moment, they are becoming more noticeable.

Good luck with all of your outcomes.

Thanks to all who've responded thus far. I plan on getting a *fasting* lipid panel within the next few weeks, and will reduce (not eliminate!) my saturated fat intake. I'll also continue my 1hr of daily exercise. Nothing strenuous; at this point, I keep my pulse between 110-120.

After my retest, I'll request the specific tests that have been mentioned.

*Mark1e*
I'm not convinced that cholesterol causes heart disease either, but in my (limited) reading, it appears that even the "alternative" theorists concede that individuals with VERY high cholesterol may in fact be at higher risk of heart disease. (I still need to find out what "very high" is.)

Regarding tests for heart disease, it amazes me that, given my high reading, this doctor didn't first consider a test to determine if I actually have CHD. It seems that lowering cholesterol is an end in itself nowadays. This may be why some people that I know were first diagnosed with CHD immediately before their first angioplasty/stent/bypass. I feel like I went to an auto mechanic because my car's "engine" light was on, and he was more concerned with getting the light to shut off than with diagnosing and fixing the engine.

*namelessme*
The triglyceride number was actually the first reason I wanted another test. I've been reading that the triglyceride/HDL ratio is a more reliable predictor of CHD than total cholesterol. A ratio below 2.0 is desirable, so if my HDL remains at 60 and my triglycerides drop to at least 120, I'll consider myself less at risk. (I don't even want to THINK about the importance of the HDL/TotalChol ratio that I've also read about until I get retested.)

*Red60*
I'm only just now re-reading about LDL. (The responses that I've been getting from friends when I tell them the number has inspired me.) I've been allowing myself some slack in my health education (just so I don't go completely insane), and I think that I subconsciously categorized the intricacies of LDL as a rainy-day topic. I guess it's time to roll up my sleeves and get to it.

*dmer*
I agree with the quality of the comments.
Your numbers are impressive! That's only over five weeks, right? But your doctor suggested that it was your lifestyle changes?!? That's confusing. What was your diet like before Pravachol? I've yet to eat any grains, refined or otherwise since Dec 2, 2007. I think it's time to bring oatmeal back into my life though. (My brother's been bugging me to eat Cheerios.)

You mention that the benefits of statins to society may be exaggerated. I'm inclined to agree. Ravnskov and Taubes touch on this in their writings. Calculating relative risk reduction can probably make MOST efficacy studies seem pretty underwhelming.

Regarding "dropping the statins." I never seem to hear of people going OFF of cholesterol-lowering meds. Is this usually the case?

*dmer*
I agree with the quality of the comments.
Your numbers are impressive! That's only over five weeks, right? But your doctor suggested that it was your lifestyle changes?!? That's confusing. What was your diet like before Pravachol? I've yet to eat any grains, refined or otherwise since Dec 2, 2007. I think it's time to bring oatmeal back into my life though. (My brother's been bugging me to eat Cheerios.)

You mention that the benefits of statins to society may be exaggerated. I'm inclined to agree. Ravnskov and Taubes touch on this in their writings. Calculating relative risk reduction can probably make MOST efficacy studies seem pretty underwhelming.

Regarding "dropping the statins." I never seem to hear of people going OFF of cholesterol-lowering meds. Is this usually the case?

My diet was terrible - daily helpings of potato chips and various other refined carbs. Total caloric intake was probably in the area of 3500-4500 per day, but I did exercise. Subsequently, I limited my daily intake to between 1600-1800 and eliminated refined carbs. I also run 3 miles daily and walk 1.6. I believe the effects of increased weight are exponential as opposed to incremental, at least for certain people. Thus, weight loss can have a very dramatic effect on lipids and blood pressure.

There is / was another poster here "cobaltblue" and a current poster "beerzoids" who have reduced and eliminated medication. Their posts are very informative.

As mentioned, my concern in your case would be familial CHD and that would likely trigger Dr.'s to prescribe a statin, even if your lipids were in a normal range.

In some respects, I don't fault the medical community for wanting to use statins, even on an empirical basis. Studies from places such as the west of Scotland and Finland where the epidemiological maps for heart disease are truly dire, show significant benefit from statin use. In some regards, studies that focus on a particular population and their outcomes may be more revealing than testing a general study group.

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Thanks for the references to the older posts, dmer. I've read or browsed through most of them.

Subsequently, I limited my daily intake to between 1600-1800 and eliminated refined carbs.

Did you lower your caloric intake simpy by eliminating the refined carbs, or have you also increased protein and/or fat?


As mentioned, my concern in your case would be familial CHD and that would likely trigger Dr.'s to prescribe a statin, even if your lipids were in a normal range.


This may be grasping at straws, but my father was overweight when he had his heart attack, and my brother was overweight and a smoker when he had his. I know that outward appearances are no indication of cardiac fitness (i.e. Jim Fix), but I think that I have a more active lifestyle and a better diet (even previous to low-carb) than these two family members.


Studies from places such as the west of Scotland and Finland where the epidemiological maps for heart disease are truly dire, show significant benefit from statin use.

Yes, I've read similar to this. Still, I wouldn't agree to statins until I knew my current level of atherosclerosis.

I would think that a definite diagnosis of atherosclerosis would PRECEDE a prescription of any cholesterol-lowering meds or other treatments.

-=-=-=-=-Aimless Rant-=-=-=-=-
If atherosclerosis is a major killer, why isn't everyone tested for atherosclerosis? Why the obsession with cholesterol?

Can a seemingly healthy 50+ person walk into a doctor's office for the first time and request a CT scan, or an exercise stress test, or an echocardiagram? I ask this question seriously. I'm interested in my cholesterol stats because I've only recently received my first results, but what I REALLY want to know is: What's the possibility of me dropping dead of a heart attack while shoveling snow, or by inadvertently increasing my exercise pulse rate by a few beats per minute? Lipid panel results (good or bad) won't answer that question for me.

When I called the local hospital to get a referral to a cardiologist a few weeks ago, I was told that I needed a "primary" to refer me. So I found myself a primary, but instead of a referral which could lead to what I would consider truly diagnostic tests, I'm offered statins. Even if I accepted the prescription, at what point would my degree of cardiac health (or illness) be diagnosed?

Sorry if these questions seem flip. I just want to know how to get some answers withOUT having to take an ambulance ride.

.... If atherosclerosis is a major killer, why isn't everyone tested for atherosclerosis? Why the obsession with cholesterol?...
Good question. My theory is that doctors treat cholesterol because the results are easy to measure. A simple blood test shows cholesterol levels, which are very responsive to drug treatment. That the linkage between cholesterol and heart attacks is tenuous, to say the least, is incidental. Doctors don't allow themselves to be distracted by this inconvenient truth.

Establishing the status of atherosclerosis is difficult and expensive. From a public health perspective, giving everyone a heart scan would be just too expensive. The other reason they don't do this is that there is no easy way to reduce calcification of the arteries. There are no drugs that can be taken that will produce a measurable improvement within a reasonable length of time. This is also why doctors test blood glucose instead of insulin levels when diagnosing type 2 diabetes. The general view is, if you can't change it, don't bother measuring it.

Having said that, if you tell your doctors what information you want and why you want it, you should be able to get their co-operation. They will want to know why you need this information, and I would think your family history of heart disease is a good enough reason.

Good Luck,

Mark

Can a seemingly healthy 50+ person walk into a doctor's office for the first time and request a CT scan, or an exercise stress test, or an echocardiagram? I ask this question seriously. I'm interested in my cholesterol stats because I've only recently received my first results, but what I REALLY want to know is: What's the possibility of me dropping dead of a heart attack while shoveling snow, or by inadvertently increasing my exercise pulse rate by a few beats per minute? Lipid panel results (good or bad) won't answer that question for me.



Your primary doc should give you a referral to a cardiologist, if you want one. Just tell them you want to have a specialist handle your lipid disorder and/or discuss possible preventative testing (stress test, etc).

The test you probably want is calcium scoring, or a neck cartoid sonogram (or whatever that test is called), which can measure plaque. A full CT scan isn't usually given unless you have symptoms, as it'll give you a hefty dose of radiation. And a nuclear stress test could have some value, albeit only if you have established (and rather major) cardiac disease already -- it won't show plaque unless your arteries are all clogged up. An echo is worth getting, just to check out your heart function and how your valves are working, although it won't tell you about plaque either.

Mark1e and namelessme:

Thank you both for your responses. I'll continue to learn about these various tests while I'm also tweaking my diet and exercise regimen.

Thanks for the references to the older posts, dmer.

Did you lower your caloric intake simpy by eliminating the refined carbs, or have you also increased protein and/or fat?

Eliminated the refined carbs and reduced protein / fat in line with the overall calorie reduction.



This may be grasping at straws, but my father was overweight when he had his heart attack, and my brother was overweight and a smoker when he had his. I know that outward appearances are no indication of cardiac fitness (i.e. Jim Fix), but I think that I have a more active lifestyle and a better diet (even previous to low-carb) than these two family members.

Your health should be better on several levels.



Yes, I've read similar to this. Still, I wouldn't agree to statins until I knew my current level of atherosclerosis.

I would think that a definite diagnosis of atherosclerosis would PRECEDE a prescription of any cholesterol-lowering meds or other treatments.

-=-=-=-=-Aimless Rant-=-=-=-=-
If atherosclerosis is a major killer, why isn't everyone tested for atherosclerosis? Why the obsession with cholesterol?

Can a seemingly healthy 50+ person walk into a doctor's office for the first time and request a CT scan, or an exercise stress test, or an echocardiagram? I ask this question seriously. I'm interested in my cholesterol stats because I've only recently received my first results, but what I REALLY want to know is: What's the possibility of me dropping dead of a heart attack while shoveling snow, or by inadvertently increasing my exercise pulse rate by a few beats per minute? Lipid panel results (good or bad) won't answer that question for me.

When I called the local hospital to get a referral to a cardiologist a few weeks ago, I was told that I needed a "primary" to refer me. So I found myself a primary, but instead of a referral which could lead to what I would consider truly diagnostic tests, I'm offered statins. Even if I accepted the prescription, at what point would my degree of cardiac health (or illness) be diagnosed?

Sorry if these questions seem flip. I just want to know how to get some answers withOUT having to take an ambulance ride.

I think that's a reasonable position. As mentioned though, if you go in with elevated BP, lipids and are overweight (each in my case) you fit a reasonable profile for being "statinised".

As far as getting diagnostic scans, I believe there are several commercial services available which will treat you as a client, without regard to referral or 3rd party reimbursement. All you would then require would be a consultation on the results.

If someone like Jim Fix had such scans before he passed away, he might still be alive. I don't know if he was on any medication for his cholesterol problem, but I think his own level and family history would have made a statin a prudent choice, even if a scan revealed a need for immediate surgical intervention.

I too have been battling cholsterol/triglycerides.Doc has me on all kinds of pills and I've been watching my diet,cutting down the fats(butter,dairy,animal)getting green vegetables and trying not to overdo the white starchy carbs.None of this has brought my levels out of high risk zone.
So at 50,I've had this problem ever since going on bp meds 8 years ago....add to that a few injuries lots of cortisone injections and a few surgeries.
I am overweight kind of like a big apple on two sticks....and I've been scouring the internet for answers because obviously the meds my doc has prescribed aren't cutting it.Another thing I have is atherosclerosis..........so I've been searching and searching for answers and I think I've found the answer.Low testosterone and high estrogen.Yep these things occur to a man when he starts to get older.And I've found at life extension foundation that these two things can give a person like myself all these problems.
I spoke to my doc about 1 1/2 years ago about hormone/Testosterone replacements....he was actually angry with me and adamantly refused saying it will give me rage and prostate cancer.The body makes more ad more cholesterol in it's effort to supply more testosterone and that testosterone produced by excess cholesterol is then converted into estrogen,and thus begins a viscious cycle and spiral towards death.
What I have since found is that by bringing a man's hormonal balance to near the levels of a young man could benefit me tremendously and turn my life around.I also found out that testosterone is not the cause of prostate cancer....high estrogen levels are.However testosterone can trigger rapid growth of prostate cancer if it already exists.
To me it's worth the risk.
It's not easy to find a doctor who is willing to work with men with hormone problems and it has taken me close to a year to find one within driving distance of me.I go to see him next week...I will bring my most recent labs.
The labs need free and total and direct testosterone ,LH,FSH,estradiol sensitive,a couple other tests...so you need to basically get a full hormone panel which includes the female hormones as well.
Your brother might not have had a heart attack if his doctor was educated on male hormones.But many doctors are not.....only the doctors who have an interest in getting to the root cause of illness are likely to be open minded in this approach.
Good luck men....I know it's not just me with these problems.