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It's great to read things like this... I wish my GP would do the same. I recently had a really high cholesterol reading (both total cholesterol and LDL). Every

It's great to read things like this... I wish my GP would do the same. I recently had a really high cholesterol reading (both total cholesterol and LDL). Everything else (blood pressure, blood glucose etc) seems fine. I'm 38, fit and healthy and nothing that suspect in my family history. I found the attitude of my doctor in all this quite surprising. It amounted basically to "You definitely have familial hypercholesterolemia. There is no other possible option here other than statins". No further questions about what I eat, my stress levels, lifestyle - nothing. What disappoints me the most here is now that I feel like it's all on me to determine what my real risk levels are and what's appropriate to treat this. I don't subscribe to the mainstream NHS view still heavily pushed that eating saturated fat -> high cholesterol == unhealthy as I think it's a lot more complicated (as this article shows). I don't like being is this situation as I'm as susceptible to human bias as the next person, and I'm not a doctor, however almost all of the high quality, science based writing I've read indicates that the mainstream healthcare system's view on cholesterol is wrong.

Swizec 11y ago
> almost all of the high quality, science based writing I've read indicates that the mainstream healthcare system's view on cholesterol is wrong. My understanding is that a doctor's first job is to be risk averse. That's why they shy away from bleeding edge research and knowledge, and choose instead to rely on proven ways. Their job isn't so much to be right as it is to not be wrong. If that means keeping you suboptimally alive, but still healthy, then so be it. Better than try to optimize and risk worsening your state.
- DiabloD3 11y ago
  The problem is, there is no research stating that lowering dietary cholesterol leads to lowered blood levels and the reversal of fatty liver disease. There is research stating that fatty liver disease exists due to long term over-production of cholesterol in the liver, caused by low dietary cholesterol, and increasing dietary cholesterol can lead to the reversal of fatty liver disease; and such research isn't really cutting edge, much of it is around a decade old now. The FDA has reversed course on this, and is no longer hammering its anti-cholesterol drum.
  - Swizec 11y ago
    > much of it is around a decade old now Has your doctor done any research/training about cholesterol in the last 10 years? I'm being snarky. But I think it's important to consider the lifecycle of doctor careers. If you go to a liver or cholesterol specialist, then I'm sure they will be up to date with even findings from the last year. But I wouldn't expect a GP to be up to date on what every field within medicine has decided in the last decade after years and years of back-and-forth. It's almost like asking a computer scientist to know both the difference between Angular and React, and how to rewrite COBOL mainframe code into Lisp. The actual job of a computer scientist is writing proofs in Coq and understanding the difference between lexical and context-free grammars.
    - copperx 11y ago
      > The actual job of a computer scientist is writing proofs in Coq I was with you, but then this analogy went too far.
    - scott_s 11y ago
      You have a misinformed view of what a "computer scientist" is; I have never written a Coq proof, but I think my publication record buys me the label "computer scientist". (I recognize you were probably usually your specific examples as examples of a kind, but it's that kind which I think is misinformed. You probably think a "computer scientist" must necessarily be a theoretician, which is not the case.)
    - Joof 11y ago
      I think you would be saved by rephrasing to indicate a particular computer scientist. People are getting overly pedantic.
      - Swizec 11y ago
        It's okay. That's how engineers and computer scientists work. The idea of "generalization" and "hyperbole" and "caricature" is often lost on us. This is primarily why my technical blogging has slowed down significantly. Writing for an audience that cares more about details than The Point (tm) is often annoying.
- epalmer 11y ago
  > My understanding is that a doctor's first job is to be risk averse. That's why they shy away from bleeding edge research and knowledge, and choose instead to rely on proven ways I think it is more a matter of relying on what other doctors are doing and as well what they think their patients will tolerate. I asked my cardiologist and primary care doctor before going on a well formulated low carb diet. they were both in favor of it but noted that they don't recommend these types of approaches, not because they don't work, but because people don't tend to stick with it. In 3 months I lost 30 lbs (got a way to go still). My primary said that I have not indication now of prediabetes while I did prior to my diet. For me I decided to take control of what I can in my health. Keep in mind your MMV.
  - TeMPOraL 11y ago
    > For me I decided to take control of what I can in my health. But you did that cooperating with your doctors, which is how it should look. The problem with people taking charge of their own health is usually that they completely reject medical professionals altogether because they "know better". It makes exactly as much sense as when a manager decides not to hire a programmer, but instead buys himself a JavaScript book, because "how hard can this programming stuff be anyway?", or "the programming establishment still uses this old Ruby stuff, they don't know JavaScript is the state-of-the art solution!". Knowing better than your doctor can lead to tragic consequences. Since we're in story-sharing mode: just last week my brother's friends saved the life of a guy who was after surgery that involved installation of stents, but for some reason didn't take the prescribed anticoagulants - he just kept the prescriptions stored in his bag and went happy about his life. He slipped up and admitted to taking no drugs on a checkup in the hospital. According to the doctor who was leading his case, he was hours from dying when they figured out what's going on.
    - dualogy 11y ago
      > It makes exactly as much sense as when a manager decides not to hire a programmer, but instead buys himself a JavaScript book, because "how hard can this programming stuff be anyway?" Hey, worked out splendidly for Derek Sivers!
    - 11y ago
DanBC 11y ago
The NICE evidence, which your NHS GP should be following, is here: http://www.nice.org.uk/guidance/cg181/evidence http://www.nice.org.uk/guidance/cg181/evidence The NICE guidance, which your NHS GP should be following, is here: http://www.nice.org.uk/guidance/cg181 http://www.nice.org.uk/guidance/cg181 Your GP should have used more information than just your non-HDL results; they should have given you a standardised risk assessment call QRISK2. http://www.nhs.uk/news/2014/02February/Pages/NICE-publishes-new-draft-guidelines-on-statins-use.aspx http://www.nhs.uk/news/2014/02February/Pages/NICE-publishes-... That risk assessment needs to know your age, sex, BMI, ethnicity, family history, your blood pressure, your blood cholesterol levels, and whether you have history of diabetes, high blood pressure, atrial fibrillation, or rheumatoid arthritis. Your GP should have most of that, and if you think they don't it's probably a good idea to let them know. You've said that you think the "eating saturated fat leads to high blood cholesterol" thing is wrong, and that the NHS seems to push this, but you also say that your GP didn't ask you what you eat, so it seems your GP isn't pushing that hypothesis. Your GP (from what you've said) didn't say "stop eating animal fat and take this medication", your GP said "take this medication".
- boothead 11y ago
  Thank you for those links! I should have been clearer: what bugged me about my interaction with the GP was that he didn't ask about anything to do with lifestyle/diet. When I went looking on my own - everything I seemed to find from the NHS/Heart UK suggested that cutting saturated fat was essential, leading to my conclusion that this is what the mainstream medical establishment still believes.
  - JeremyNT 11y ago
    As somebody in the same situation (same age, otherwise healthy, high cholesterol, regular exercise) my read is that trying to influence ldl in a meaningful way through diet alone is essentially pointless. You can knock off a few points, and you can raise HDL a bit, but the likelihood of a dramatic reduction is essentially nil. Going right for the statins kind of makes sense beyond a certain point. That said, I opted out. My gp showed me the risk in the calculator mentioned above and the difference statins made was not large enough for me to justify it.
tkyjonathan 11y ago
Take matters into your own hands and change your diet. Nothing beats a high anti-inflammatory whole-foods plant-based diet. Check the research.
- boothead 11y ago
  Indeed, that's what I've done. I've completely eliminated sugar and I've increased my veg intake. As of the end of last week urine strips indicate that I'm in ketosis. I'll have another set of bloods done this week before I go to see a specialist probably after xmas. I intend to take a very self experimental approach with this. At the same time, if it does turn out that I'm one of those people who doesn't metabolize saturated fat well, or I do in fact have a genetic mutation then I'll also have to consider the drug route I suppose.
  - atomical 11y ago
    "A plant-based diet is a diet of any animal (including humans) based on foods derived from plants, including vegetables, whole grains, legumes and fruits, but with few or no animal products." https://en.wikipedia.org/wiki/Plant-based_diet https://en.wikipedia.org/wiki/Plant-based_diet
  - tertius 11y ago
    How can I get in contact with you? I'm in the same boat.
    - tome 11y ago
      https://twitter.com/boothead https://twitter.com/boothead
- copperx 11y ago
  Doesn't the TFA address this and basically says that there's no anti-inflammatory diet except a strict liquid one delivered through the nose?
- JupiterMoon 11y ago
atomical 11y ago
It comes down to diet. My LDL is 66 and my HDL is 75. I don't eat eggs, meat, or cheese. Basically, nothing that has cholesterol. My numbers will probably be even better this year. I have looked at /r/keto and /r/paleo. Their cholesterol numbers aren't good.
- LunaSea 11y ago
  I've stopped eating all together and my stats are out of this world.
  - kaeluka 11y ago
    Why the snark?
- boothead 11y ago
  The problem is now that I'm not even sure whether I should agree with what a "good" or "bad" number is for LDL or TC. The recommended number seems to fall every few years, and I'm unsure how much of that is based on good research or industry pressure or what.
- dspillett 11y ago
  Recent research suggests that cholesterol directly in food isn't a major problem because most of it passes through the digestive system untouched. The problem is actually cholesterol produced by the body using other substances. 80% or more of the cholesterol in your body is produced by your body, no more than 20% of it comes from your diet unless your diet is particularly unbalanced in that manner. The reason cholesterol in people's diet got the blame is that there is often a strong correlation between the foods containing substances that do cause increased cholesterol in the body and foods containing significant amounts of cholesterol, and a similar correlation between certain lifestyle options that are risk factors for heart problems generally and eating those foods. So blindly reducing cholesterol in your diet is not useful and may lead you into a false sense of security - you could still be taking in the other stuff and living your life in a way that will encourage the body to produce too much cholesterol itself.
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copperx 11y ago
I recently visited my GP and I had a high cholesterol reading. He suggested me to reduce sugars and white flours, get a reading in a month, and depending on that he'll decide whether to prescribe statins. It surprised me that he didn't mention reducing saturated fats or meat consumption. It made me wonder whether refined carbohydrates play a role in high cholesterol. I think I'll have to take a look at the research.
- boothead 11y ago
  I'd give Peter Attia a look: http://eatingacademy.com/start-here http://eatingacademy.com/start-here His writing is incredibly in depth, and he's covered cholesterol extensively.
  - noondip 11y ago
    Also be sure to see the following very critical review of this person begging us for money - http://plantpositive.com/a-very-serious-low-carber-nusi/ http://plantpositive.com/a-very-serious-low-carber-nusi/
- jawilson2 11y ago
  I've collected a lot of research on low-carb diets. In my previous job as a neurology professor, I had access to all of the most medical journals, and was able to save a lot. I have been on a ketogenic diet for 2 years now, and my LDL cholesterol went from 180 to 130, my HDL from 28 to 80, and my triglycerides from 140 to 75. Plus, I lost 70 pounds, no migraines for 2 years, and my anxiety and depression have all but disappeared. 75% of my calories are from fat (50/50 saturated/unsaturated, mostly from red meat, oils including coconut, olive, and avacodo, butter, plus a TON of vegetables). This is pretty typical. https://drive.google.com/open?id=0BzEPvoDPVTV5SzJlSHV0Y21rZ0k https://drive.google.com/open?id=0BzEPvoDPVTV5SzJlSHV0Y21rZ0... On page 29, there is a cool paper showing ultrasound cross-sections of blood vessels before and after a low-carb diet, and the resulting dramatic decrease in inflammation.
  - copperx 11y ago
    That's great! I've saved the document. Seeing now that you were a neurology prof, I have a question. About 10 years ago I followed a diet similar to the [Slow Carb Diet](https://en.wikipedia.org/wiki/Slow-Carb_Diet https://en.wikipedia.org/wiki/Slow-Carb_Diet) in order to lose fat slowly over a long period of time. One of the unexpected side effects was that I felt extremely clear-headed. I was doing software development at the time and I remember being able to breeze through some thinking tasks. Years later, I was feeling foggy so I used Modafinil and it gave me a similar effect. The low-carb acted as a nootropic on me. Is there any mechanism that you know about that could make this possible? Or was it all on my head?
kefka 11y ago
Unfortunately, join the club. I was diagnosed with type 2 diabetes. My initial fasting glucose was 161 and a1c was 7.1 . Not prediabates, but full on type 2. So what does the GP say? "Here's some metformin. Oh look, high blood pressure. Here's some statins." So, what do I do? Certainly not the doctor's advice. He didn't even give me the correct blood-sugar level in which damage is known to be caused (neurons die at 140mg/dL, no ifs ands or buts). Doc said 150mg/dL. I've posted recently in what I'm doing, but esentially comes down to diet. Turns out that net carbs (or total carbs-fiber) is what causes my body to go haywire. Cutting down to about 10-20g carbs has done well for me. Since doing only pure diet, 6 days is what it took for my body to start to noticeably fix itself. Now, my blood sugar doesn't go over 120, and my wake-up (fasting) glucose has tested at 100 the last 2 days. Look up "Eating to the meter". If you can't measure, you can't reliably react and project. It's what I'm doing, and it's working. I have my data to prove it.
- boothead 11y ago
  Thanks for sharing. I've taken a similar approach: cut all crap out of my diet and now in ketosis (according to urine strips). Ultimately this might not be the fix for me, and I might have to add some other interventions (like replacing saturated fat with polyunsaturated fat if I turn out to metabolize SFA poorly) but I'm also convinced that the primary fix must be dietary/lifestyle with some limited support from medication if necessary.
  - dualogy 11y ago
    > if I turn out to metabolize SFA poorly Is that a thing? Humans metabolizing Saturated Fats badly? I mean, I know of gall-bladder deterioration after maybe years of very-low-fat eating, but other than that. Would these people also weirdly burn their own body fat (saturated) "badly"? ;)
    - boothead 11y ago
      It would seem so: http://eatingacademy.com/cholesterol-2/random-finding-plus-pi http://eatingacademy.com/cholesterol-2/random-finding-plus-p... I think that's essentially what a diagnosis of familial hypercholesterolemia means. Likewise people seem to vary widely in their ability to handle high carb diets. I guess a cookie cutter approach doesn't really work across the board.
coldtea 11y ago
On the other hand your GP examined you and has an actual medical degree while you just read some articles on the internet...
- boothead 11y ago
  Yes, this is a very good point that I try to keep uppermost in my mind. The thing is though that I'm not sure that having a medical degree and several years as a GP actually gives you much more of a grounding in non-drug therapies than someone who can read the original research (or in my case well referenced and balanced synopses of said research by people who's opinion I trust). Which is where my vague sense of disappointment comes in: the only intervention that a doctor within mainstream medicine seems to countenance is a prescription.
  - coldtea 11y ago
    >actually gives you much more of a grounding in non-drug therapies than someone who can read the original research I don't think one can actually "read the original research" (with the all the prerequisite and pressupossed knowledge that entails) without either having been to medical school and have similar training of his own to such a level. Having access to said research and being able to read it (in the nominal sense) is not the same as actually being able to "read it" (e.g. understand all that it entails, even things that are not explicitly said). Even less so for "well referenced and balanced synopses of said research from people one's trust" unless said people are doctors AND have examined you personally. Some well respected pop science journalist's online synopses won't cut it. In case you doubt your doctor's results, which can of course be not up to par (doctors are fallible too) the prudent thing to do would be to seek counsel with another doctor(s) for a second opinion.
    - boothead 11y ago
      Yes you're absolutely correct, I'm waiting for a referral to a specialist at the moment. WRT to my examination though: it didn't go beyond having bloods done. There was no other investigation other than, wow your LDL is really high. My go to source for understanding this stuff is Peter Attia [1], and a few other independent researchers. [1] http://eatingacademy.com/nutrition/the-straight-dope-on-cholesterol-part-i http://eatingacademy.com/nutrition/the-straight-dope-on-chol...
calebm 11y ago
I have a friend who is a pharmacist, and she warned strongly against statins. Among other drawbacks, statins kill sex drive.
gmarx 11y ago
I'm an M.D. and let me first say this is not medical advice :). I long ago called bunk on the mainstream view on cholesterol and cholesterol lowering drugs. I think there will be a time in the future when doctors look back on it with a "what the heck were we thinking" kind of retrospective smugness. That stated, familial hypercholesterolemia is a different thing and it's no joke. It's been a long time since med school but I think in this case the cholesterol gets high enough that it actually is a plumbing problem. That is your arteries will get gummed up with all that extra cholesterol. By all means do your research but don't let denial prevent you from treating this properly. Listen to your doc or get a second opinion
- boothead 11y ago
  Thank you for your perspective. I am very wary of treading the "mainstream medicine doesn't know shit and drugs are bad" path, and for that reason I very much appreciate a contrary view. My plan is to give it a few months and see if fixing some of my sub optimal lifestyle makes a difference or not. I figure if I fix my sleep, cut the sugar and other crap and if necessary change my SFA to PUFA ratio and it doesn't get much better in 6 months then I'll have to take the pills. But I owe it to myself to try first.
  - pkaye 11y ago
    How is you tryglyceride levels? That should be easy to change with just a diet alone. I believe it is due to consuming excess calories than you really need.
    - boothead 11y ago
      Trigs were fine. Overconsumption is certainly one more thing for me to look at.
      - teslabox 11y ago
        Broda Barnes book [1] says, iirc, that high cholesterol levels are basically diagnostic of hypothyroidism. Usually people's superficial thyroid lab #'s look fine (TSH), but their body is not properly activating T4 -> T3. [1] https://books.google.com/books?id=TJXf2ZqoxUIC https://books.google.com/books?id=TJXf2ZqoxUIC
brandonmenc 11y ago
> No further questions about what I eat, my stress levels, lifestyle - nothing. A friend has familial hypercholesterolemia - cholesterol levels were around 1000 as a child, on statins since like, age 10. At their request, the doctor dialed back the statin dose and cholesterol levels shot back up within days - even on a vegetarian diet with plenty of exercise. They asked if they could start eating egg yolks again and the doctor said something like, "Go ahead. Your diet does not affect this condition at all." Familial hypercholesterolemia isn't the same thing as having a 300 cholesterol level because you eat McDonald's. Listen to your doctor - they do know some things.
- boothead 11y ago
  Absolutely, agree with all of that. What I'm moaning about is the absence of desire to explore further. I don't know if I've had high cholesterol for a long time or not or whether it's lifestyle or not, or whether I do actually have a 1 in 500 genetic mutation that means that my liver doesn't process cholesterol correctly or not. I want to look into some of those possibilities a bit more before I take drugs for the rest of my life is all :-)
  - QSIITurbo 11y ago
    The thing is, if you have familial hypercholesterolemia, some forms have life expectancy of 35 without medications. Patients might have severe atherosclerosis at the age of 10. There is a seriously heightened risk of CVD mortality without statins no matter what you eat or how hard you exercise if you really have it. So in that case your doctor is correct: there's nothing you can do but take medication. But what were your lab results for LDL?
    - brandonmenc 11y ago
      > some forms have life expectancy of 35 without medications This. You don't have a lot of time to experiment. My guess is it's best to listen to your doctor and get on statins immediately. Then alter your diet and activity level, and after that try cranking back the statin to see if the lifestyle changes took.
jpmattia 11y ago
> What disappoints me the most here is now that I feel like it's all on me to determine what my real risk levels are and what's appropriate to treat this. A convoluted set of circumstances led me to a quick detour in grad school, to sit in on Anatomy at Harvard Med. This included the dissection portion, in which four med students hunch over the cadaver for 3-4 hours at a time. It lead to some of the best medical conversation I've had in my life. The best topic was summarized as: When you visit a doctor, odds are that he/she has about 15 minutes to an hour to evaluate you before moving onto the next case (often because there are bills to pay.) If you are not an expert on your particular medical history and circumstances, then you are basically screwed, because there is nobody human who can digest all of your medical history and circumstances in the allotted amount of time. It still essentially holds true if you have some serious condition: Consider all of the other patients on the doctor's plate. That, combined with several other stories and experiences, had a big effect on me: It became obvious that it is worth enormous amounts of time and money to keep fit. When it comes to the med community, the only way to win is not to play.
- LordKano 11y ago
  I had an issue a few years ago. I was having frequent acid reflux and 2-3 nights a week, I'd wake up choking on it. This lead to issues with difficulty breathing and shortness of breath. My doctor treated me with an inhaled steroid for the breathing difficulty and a PPI for the reflux. This helped but it didn't fix the problem. I'd wake up choking once every couple of weeks and this was not acceptable to me. I started googling for my symptoms and I found someone who had a stomach infection that was causing his reflux, when he treated that infection, the reflux stopped. I tried to get my doctor to run tests and he wouldn't. I went to a gastroenterologist and began asking him to test me for infections. He stated that the only possible thing that could survive in the acidic environment of my stomach was H. Pylori and since a gastroscopy didn't find any evidence of ulcers, I couldn't possibly have an H. Pylori infection. I was insistent that I be tested for it... Two days later, I got a call that I did have an H. Pylori infection and the doctor would call in a prescription. I took a ten day course of antibiotics and a PPI. Almost miraculously, I was cured. No more stomach discomfort. Almost no night time reflux. I wake up choking maybe once in 6-8 months. I am breathing better. I was damaging my lungs for years and it's taking time to recover from that damage but things are constantly improving. Basically, I would be in much worse health if I hadn't sought out the experiences of other people and if I hadn't pushed back against the advice of my doctors.
carbocation 11y ago
The interventional studies which have clearly demonstrated an effect of diet on cardiovascular risk are the Lyons Heart Study (for prevention of a second event after a first) and the PREDIMED study (for primary prevention). The broad takeaways are that a Mediterranean diet may reduce risk, and more specifically, supplementing a diet with extra-virgin olive oil and some nuts seems to be beneficial. The magnitude of the effect of diet (for people without specific monogenic dyslipidemias) is not large, probably in part because most cholesterol in the body is produced by the body. In many circumstances – especially in the case of familial hypercholesterolemia – diet and exercise will not achieve an acceptable risk reduction. I would conclude by saying that your GP could have engaged with you more effectively to achieve a mutually agreeable outcome. Nevertheless, if you think "cholesterol == unhealthy", this is an acceptable gestalt understanding under the modern Western diet.

Swizec 11y ago

> almost all of the high quality, science based writing I've read indicates that the mainstream healthcare system's view on cholesterol is wrong. My understanding is that a doctor's first job is to be risk averse. That's why they shy away from bleeding edge research and knowledge, and choose instead to rely on proven ways. Their job isn't so much to be right as it is to not be wrong. If that means keeping you suboptimally alive, but still healthy, then so be it. Better than try to optimize and risk worsening your state.

DiabloD3 11y ago
The problem is, there is no research stating that lowering dietary cholesterol leads to lowered blood levels and the reversal of fatty liver disease. There is research stating that fatty liver disease exists due to long term over-production of cholesterol in the liver, caused by low dietary cholesterol, and increasing dietary cholesterol can lead to the reversal of fatty liver disease; and such research isn't really cutting edge, much of it is around a decade old now. The FDA has reversed course on this, and is no longer hammering its anti-cholesterol drum.
- Swizec 11y ago
  > much of it is around a decade old now Has your doctor done any research/training about cholesterol in the last 10 years? I'm being snarky. But I think it's important to consider the lifecycle of doctor careers. If you go to a liver or cholesterol specialist, then I'm sure they will be up to date with even findings from the last year. But I wouldn't expect a GP to be up to date on what every field within medicine has decided in the last decade after years and years of back-and-forth. It's almost like asking a computer scientist to know both the difference between Angular and React, and how to rewrite COBOL mainframe code into Lisp. The actual job of a computer scientist is writing proofs in Coq and understanding the difference between lexical and context-free grammars.
  - copperx 11y ago
    > The actual job of a computer scientist is writing proofs in Coq I was with you, but then this analogy went too far.
  - scott_s 11y ago
    You have a misinformed view of what a "computer scientist" is; I have never written a Coq proof, but I think my publication record buys me the label "computer scientist". (I recognize you were probably usually your specific examples as examples of a kind, but it's that kind which I think is misinformed. You probably think a "computer scientist" must necessarily be a theoretician, which is not the case.)
  - Joof 11y ago
    I think you would be saved by rephrasing to indicate a particular computer scientist. People are getting overly pedantic.
    - Swizec 11y ago
      It's okay. That's how engineers and computer scientists work. The idea of "generalization" and "hyperbole" and "caricature" is often lost on us. This is primarily why my technical blogging has slowed down significantly. Writing for an audience that cares more about details than The Point (tm) is often annoying.
epalmer 11y ago
> My understanding is that a doctor's first job is to be risk averse. That's why they shy away from bleeding edge research and knowledge, and choose instead to rely on proven ways I think it is more a matter of relying on what other doctors are doing and as well what they think their patients will tolerate. I asked my cardiologist and primary care doctor before going on a well formulated low carb diet. they were both in favor of it but noted that they don't recommend these types of approaches, not because they don't work, but because people don't tend to stick with it. In 3 months I lost 30 lbs (got a way to go still). My primary said that I have not indication now of prediabetes while I did prior to my diet. For me I decided to take control of what I can in my health. Keep in mind your MMV.
- TeMPOraL 11y ago
  > For me I decided to take control of what I can in my health. But you did that cooperating with your doctors, which is how it should look. The problem with people taking charge of their own health is usually that they completely reject medical professionals altogether because they "know better". It makes exactly as much sense as when a manager decides not to hire a programmer, but instead buys himself a JavaScript book, because "how hard can this programming stuff be anyway?", or "the programming establishment still uses this old Ruby stuff, they don't know JavaScript is the state-of-the art solution!". Knowing better than your doctor can lead to tragic consequences. Since we're in story-sharing mode: just last week my brother's friends saved the life of a guy who was after surgery that involved installation of stents, but for some reason didn't take the prescribed anticoagulants - he just kept the prescriptions stored in his bag and went happy about his life. He slipped up and admitted to taking no drugs on a checkup in the hospital. According to the doctor who was leading his case, he was hours from dying when they figured out what's going on.
  - dualogy 11y ago
    > It makes exactly as much sense as when a manager decides not to hire a programmer, but instead buys himself a JavaScript book, because "how hard can this programming stuff be anyway?" Hey, worked out splendidly for Derek Sivers!
  - 11y ago

DanBC 11y ago

The NICE evidence, which your NHS GP should be following, is here: http://www.nice.org.uk/guidance/cg181/evidence http://www.nice.org.uk/guidance/cg181/evidence The NICE guidance, which your NHS GP should be following, is here: http://www.nice.org.uk/guidance/cg181 http://www.nice.org.uk/guidance/cg181 Your GP should have used more information than just your non-HDL results; they should have given you a standardised risk assessment call QRISK2. http://www.nhs.uk/news/2014/02February/Pages/NICE-publishes-new-draft-guidelines-on-statins-use.aspx http://www.nhs.uk/news/2014/02February/Pages/NICE-publishes-... That risk assessment needs to know your age, sex, BMI, ethnicity, family history, your blood pressure, your blood cholesterol levels, and whether you have history of diabetes, high blood pressure, atrial fibrillation, or rheumatoid arthritis. Your GP should have most of that, and if you think they don't it's probably a good idea to let them know. You've said that you think the "eating saturated fat leads to high blood cholesterol" thing is wrong, and that the NHS seems to push this, but you also say that your GP didn't ask you what you eat, so it seems your GP isn't pushing that hypothesis. Your GP (from what you've said) didn't say "stop eating animal fat and take this medication", your GP said "take this medication".

boothead 11y ago
Thank you for those links! I should have been clearer: what bugged me about my interaction with the GP was that he didn't ask about anything to do with lifestyle/diet. When I went looking on my own - everything I seemed to find from the NHS/Heart UK suggested that cutting saturated fat was essential, leading to my conclusion that this is what the mainstream medical establishment still believes.
- JeremyNT 11y ago
  As somebody in the same situation (same age, otherwise healthy, high cholesterol, regular exercise) my read is that trying to influence ldl in a meaningful way through diet alone is essentially pointless. You can knock off a few points, and you can raise HDL a bit, but the likelihood of a dramatic reduction is essentially nil. Going right for the statins kind of makes sense beyond a certain point. That said, I opted out. My gp showed me the risk in the calculator mentioned above and the difference statins made was not large enough for me to justify it.

tkyjonathan 11y ago

Take matters into your own hands and change your diet. Nothing beats a high anti-inflammatory whole-foods plant-based diet. Check the research.

boothead 11y ago
Indeed, that's what I've done. I've completely eliminated sugar and I've increased my veg intake. As of the end of last week urine strips indicate that I'm in ketosis. I'll have another set of bloods done this week before I go to see a specialist probably after xmas. I intend to take a very self experimental approach with this. At the same time, if it does turn out that I'm one of those people who doesn't metabolize saturated fat well, or I do in fact have a genetic mutation then I'll also have to consider the drug route I suppose.
- atomical 11y ago
  "A plant-based diet is a diet of any animal (including humans) based on foods derived from plants, including vegetables, whole grains, legumes and fruits, but with few or no animal products." https://en.wikipedia.org/wiki/Plant-based_diet https://en.wikipedia.org/wiki/Plant-based_diet
- tertius 11y ago
  How can I get in contact with you? I'm in the same boat.
  - tome 11y ago
    https://twitter.com/boothead https://twitter.com/boothead
copperx 11y ago
Doesn't the TFA address this and basically says that there's no anti-inflammatory diet except a strict liquid one delivered through the nose?
JupiterMoon 11y ago

atomical 11y ago

It comes down to diet. My LDL is 66 and my HDL is 75. I don't eat eggs, meat, or cheese. Basically, nothing that has cholesterol. My numbers will probably be even better this year. I have looked at /r/keto and /r/paleo. Their cholesterol numbers aren't good.

LunaSea 11y ago
I've stopped eating all together and my stats are out of this world.
- kaeluka 11y ago
  Why the snark?
boothead 11y ago
The problem is now that I'm not even sure whether I should agree with what a "good" or "bad" number is for LDL or TC. The recommended number seems to fall every few years, and I'm unsure how much of that is based on good research or industry pressure or what.
dspillett 11y ago
Recent research suggests that cholesterol directly in food isn't a major problem because most of it passes through the digestive system untouched. The problem is actually cholesterol produced by the body using other substances. 80% or more of the cholesterol in your body is produced by your body, no more than 20% of it comes from your diet unless your diet is particularly unbalanced in that manner. The reason cholesterol in people's diet got the blame is that there is often a strong correlation between the foods containing substances that do cause increased cholesterol in the body and foods containing significant amounts of cholesterol, and a similar correlation between certain lifestyle options that are risk factors for heart problems generally and eating those foods. So blindly reducing cholesterol in your diet is not useful and may lead you into a false sense of security - you could still be taking in the other stuff and living your life in a way that will encourage the body to produce too much cholesterol itself.

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copperx 11y ago

I recently visited my GP and I had a high cholesterol reading. He suggested me to reduce sugars and white flours, get a reading in a month, and depending on that he'll decide whether to prescribe statins. It surprised me that he didn't mention reducing saturated fats or meat consumption. It made me wonder whether refined carbohydrates play a role in high cholesterol. I think I'll have to take a look at the research.

boothead 11y ago
I'd give Peter Attia a look: http://eatingacademy.com/start-here http://eatingacademy.com/start-here His writing is incredibly in depth, and he's covered cholesterol extensively.
- noondip 11y ago
  Also be sure to see the following very critical review of this person begging us for money - http://plantpositive.com/a-very-serious-low-carber-nusi/ http://plantpositive.com/a-very-serious-low-carber-nusi/
jawilson2 11y ago
I've collected a lot of research on low-carb diets. In my previous job as a neurology professor, I had access to all of the most medical journals, and was able to save a lot. I have been on a ketogenic diet for 2 years now, and my LDL cholesterol went from 180 to 130, my HDL from 28 to 80, and my triglycerides from 140 to 75. Plus, I lost 70 pounds, no migraines for 2 years, and my anxiety and depression have all but disappeared. 75% of my calories are from fat (50/50 saturated/unsaturated, mostly from red meat, oils including coconut, olive, and avacodo, butter, plus a TON of vegetables). This is pretty typical. https://drive.google.com/open?id=0BzEPvoDPVTV5SzJlSHV0Y21rZ0k https://drive.google.com/open?id=0BzEPvoDPVTV5SzJlSHV0Y21rZ0... On page 29, there is a cool paper showing ultrasound cross-sections of blood vessels before and after a low-carb diet, and the resulting dramatic decrease in inflammation.
- copperx 11y ago
  That's great! I've saved the document. Seeing now that you were a neurology prof, I have a question. About 10 years ago I followed a diet similar to the [Slow Carb Diet](https://en.wikipedia.org/wiki/Slow-Carb_Diet https://en.wikipedia.org/wiki/Slow-Carb_Diet) in order to lose fat slowly over a long period of time. One of the unexpected side effects was that I felt extremely clear-headed. I was doing software development at the time and I remember being able to breeze through some thinking tasks. Years later, I was feeling foggy so I used Modafinil and it gave me a similar effect. The low-carb acted as a nootropic on me. Is there any mechanism that you know about that could make this possible? Or was it all on my head?

kefka 11y ago

Unfortunately, join the club. I was diagnosed with type 2 diabetes. My initial fasting glucose was 161 and a1c was 7.1 . Not prediabates, but full on type 2. So what does the GP say? "Here's some metformin. Oh look, high blood pressure. Here's some statins." So, what do I do? Certainly not the doctor's advice. He didn't even give me the correct blood-sugar level in which damage is known to be caused (neurons die at 140mg/dL, no ifs ands or buts). Doc said 150mg/dL. I've posted recently in what I'm doing, but esentially comes down to diet. Turns out that net carbs (or total carbs-fiber) is what causes my body to go haywire. Cutting down to about 10-20g carbs has done well for me. Since doing only pure diet, 6 days is what it took for my body to start to noticeably fix itself. Now, my blood sugar doesn't go over 120, and my wake-up (fasting) glucose has tested at 100 the last 2 days. Look up "Eating to the meter". If you can't measure, you can't reliably react and project. It's what I'm doing, and it's working. I have my data to prove it.

boothead 11y ago
Thanks for sharing. I've taken a similar approach: cut all crap out of my diet and now in ketosis (according to urine strips). Ultimately this might not be the fix for me, and I might have to add some other interventions (like replacing saturated fat with polyunsaturated fat if I turn out to metabolize SFA poorly) but I'm also convinced that the primary fix must be dietary/lifestyle with some limited support from medication if necessary.
- dualogy 11y ago
  > if I turn out to metabolize SFA poorly Is that a thing? Humans metabolizing Saturated Fats badly? I mean, I know of gall-bladder deterioration after maybe years of very-low-fat eating, but other than that. Would these people also weirdly burn their own body fat (saturated) "badly"? ;)
  - boothead 11y ago
    It would seem so: http://eatingacademy.com/cholesterol-2/random-finding-plus-pi http://eatingacademy.com/cholesterol-2/random-finding-plus-p... I think that's essentially what a diagnosis of familial hypercholesterolemia means. Likewise people seem to vary widely in their ability to handle high carb diets. I guess a cookie cutter approach doesn't really work across the board.

coldtea 11y ago

On the other hand your GP examined you and has an actual medical degree while you just read some articles on the internet...

boothead 11y ago
Yes, this is a very good point that I try to keep uppermost in my mind. The thing is though that I'm not sure that having a medical degree and several years as a GP actually gives you much more of a grounding in non-drug therapies than someone who can read the original research (or in my case well referenced and balanced synopses of said research by people who's opinion I trust). Which is where my vague sense of disappointment comes in: the only intervention that a doctor within mainstream medicine seems to countenance is a prescription.
- coldtea 11y ago
  >actually gives you much more of a grounding in non-drug therapies than someone who can read the original research I don't think one can actually "read the original research" (with the all the prerequisite and pressupossed knowledge that entails) without either having been to medical school and have similar training of his own to such a level. Having access to said research and being able to read it (in the nominal sense) is not the same as actually being able to "read it" (e.g. understand all that it entails, even things that are not explicitly said). Even less so for "well referenced and balanced synopses of said research from people one's trust" unless said people are doctors AND have examined you personally. Some well respected pop science journalist's online synopses won't cut it. In case you doubt your doctor's results, which can of course be not up to par (doctors are fallible too) the prudent thing to do would be to seek counsel with another doctor(s) for a second opinion.
  - boothead 11y ago
    Yes you're absolutely correct, I'm waiting for a referral to a specialist at the moment. WRT to my examination though: it didn't go beyond having bloods done. There was no other investigation other than, wow your LDL is really high. My go to source for understanding this stuff is Peter Attia [1], and a few other independent researchers. [1] http://eatingacademy.com/nutrition/the-straight-dope-on-cholesterol-part-i http://eatingacademy.com/nutrition/the-straight-dope-on-chol...

calebm 11y ago

I have a friend who is a pharmacist, and she warned strongly against statins. Among other drawbacks, statins kill sex drive.

gmarx 11y ago

I'm an M.D. and let me first say this is not medical advice :). I long ago called bunk on the mainstream view on cholesterol and cholesterol lowering drugs. I think there will be a time in the future when doctors look back on it with a "what the heck were we thinking" kind of retrospective smugness. That stated, familial hypercholesterolemia is a different thing and it's no joke. It's been a long time since med school but I think in this case the cholesterol gets high enough that it actually is a plumbing problem. That is your arteries will get gummed up with all that extra cholesterol. By all means do your research but don't let denial prevent you from treating this properly. Listen to your doc or get a second opinion

boothead 11y ago
Thank you for your perspective. I am very wary of treading the "mainstream medicine doesn't know shit and drugs are bad" path, and for that reason I very much appreciate a contrary view. My plan is to give it a few months and see if fixing some of my sub optimal lifestyle makes a difference or not. I figure if I fix my sleep, cut the sugar and other crap and if necessary change my SFA to PUFA ratio and it doesn't get much better in 6 months then I'll have to take the pills. But I owe it to myself to try first.
- pkaye 11y ago
  How is you tryglyceride levels? That should be easy to change with just a diet alone. I believe it is due to consuming excess calories than you really need.
  - boothead 11y ago
    Trigs were fine. Overconsumption is certainly one more thing for me to look at.
    - teslabox 11y ago
      Broda Barnes book [1] says, iirc, that high cholesterol levels are basically diagnostic of hypothyroidism. Usually people's superficial thyroid lab #'s look fine (TSH), but their body is not properly activating T4 -> T3. [1] https://books.google.com/books?id=TJXf2ZqoxUIC https://books.google.com/books?id=TJXf2ZqoxUIC

brandonmenc 11y ago

> No further questions about what I eat, my stress levels, lifestyle - nothing. A friend has familial hypercholesterolemia - cholesterol levels were around 1000 as a child, on statins since like, age 10. At their request, the doctor dialed back the statin dose and cholesterol levels shot back up within days - even on a vegetarian diet with plenty of exercise. They asked if they could start eating egg yolks again and the doctor said something like, "Go ahead. Your diet does not affect this condition at all." Familial hypercholesterolemia isn't the same thing as having a 300 cholesterol level because you eat McDonald's. Listen to your doctor - they do know some things.

boothead 11y ago
Absolutely, agree with all of that. What I'm moaning about is the absence of desire to explore further. I don't know if I've had high cholesterol for a long time or not or whether it's lifestyle or not, or whether I do actually have a 1 in 500 genetic mutation that means that my liver doesn't process cholesterol correctly or not. I want to look into some of those possibilities a bit more before I take drugs for the rest of my life is all :-)
- QSIITurbo 11y ago
  The thing is, if you have familial hypercholesterolemia, some forms have life expectancy of 35 without medications. Patients might have severe atherosclerosis at the age of 10. There is a seriously heightened risk of CVD mortality without statins no matter what you eat or how hard you exercise if you really have it. So in that case your doctor is correct: there's nothing you can do but take medication. But what were your lab results for LDL?
  - brandonmenc 11y ago
    > some forms have life expectancy of 35 without medications This. You don't have a lot of time to experiment. My guess is it's best to listen to your doctor and get on statins immediately. Then alter your diet and activity level, and after that try cranking back the statin to see if the lifestyle changes took.

jpmattia 11y ago

> What disappoints me the most here is now that I feel like it's all on me to determine what my real risk levels are and what's appropriate to treat this. A convoluted set of circumstances led me to a quick detour in grad school, to sit in on Anatomy at Harvard Med. This included the dissection portion, in which four med students hunch over the cadaver for 3-4 hours at a time. It lead to some of the best medical conversation I've had in my life. The best topic was summarized as: When you visit a doctor, odds are that he/she has about 15 minutes to an hour to evaluate you before moving onto the next case (often because there are bills to pay.) If you are not an expert on your particular medical history and circumstances, then you are basically screwed, because there is nobody human who can digest all of your medical history and circumstances in the allotted amount of time. It still essentially holds true if you have some serious condition: Consider all of the other patients on the doctor's plate. That, combined with several other stories and experiences, had a big effect on me: It became obvious that it is worth enormous amounts of time and money to keep fit. When it comes to the med community, the only way to win is not to play.

LordKano 11y ago
I had an issue a few years ago. I was having frequent acid reflux and 2-3 nights a week, I'd wake up choking on it. This lead to issues with difficulty breathing and shortness of breath. My doctor treated me with an inhaled steroid for the breathing difficulty and a PPI for the reflux. This helped but it didn't fix the problem. I'd wake up choking once every couple of weeks and this was not acceptable to me. I started googling for my symptoms and I found someone who had a stomach infection that was causing his reflux, when he treated that infection, the reflux stopped. I tried to get my doctor to run tests and he wouldn't. I went to a gastroenterologist and began asking him to test me for infections. He stated that the only possible thing that could survive in the acidic environment of my stomach was H. Pylori and since a gastroscopy didn't find any evidence of ulcers, I couldn't possibly have an H. Pylori infection. I was insistent that I be tested for it... Two days later, I got a call that I did have an H. Pylori infection and the doctor would call in a prescription. I took a ten day course of antibiotics and a PPI. Almost miraculously, I was cured. No more stomach discomfort. Almost no night time reflux. I wake up choking maybe once in 6-8 months. I am breathing better. I was damaging my lungs for years and it's taking time to recover from that damage but things are constantly improving. Basically, I would be in much worse health if I hadn't sought out the experiences of other people and if I hadn't pushed back against the advice of my doctors.

carbocation 11y ago

The interventional studies which have clearly demonstrated an effect of diet on cardiovascular risk are the Lyons Heart Study (for prevention of a second event after a first) and the PREDIMED study (for primary prevention). The broad takeaways are that a Mediterranean diet may reduce risk, and more specifically, supplementing a diet with extra-virgin olive oil and some nuts seems to be beneficial. The magnitude of the effect of diet (for people without specific monogenic dyslipidemias) is not large, probably in part because most cholesterol in the body is produced by the body. In many circumstances – especially in the case of familial hypercholesterolemia – diet and exercise will not achieve an acceptable risk reduction. I would conclude by saying that your GP could have engaged with you more effectively to achieve a mutually agreeable outcome. Nevertheless, if you think "cholesterol == unhealthy", this is an acceptable gestalt understanding under the modern Western diet.