Need help staying low carb and improving cholesterol/lipid profile-please help!
I wrote a book (so scroll down if you have time to get the background info & full story) but in a gist if you don't have time...
Hubby, on low carbing (50 and under a day net) lost weight (30 lbs or so and is now pretty much at goal weight), VASTLY improved BP & blood sugar, liver enzymes and kidney function- but had a pretty ugly increase in his lipid profile (a little on raising his HDL which had been impossible to raise before low carbing) but mostly LDL on his first test since starting low carb 10 months ago.
JUNE 2013 (10 months low carb, 6 months of maintenance) VS Sept 2012 (pre low carb, eating low fat, just diagnosed as diabetic with a fasting of 140 and sugar going up 100 points from one bowl of oatmeal eaten with nothing in it or with it-and yet they kept saying he still needed to keep eating the oatmeal!)
Total Cholesterol: 260 (up 98 points from pre low carb total of 162) (his total has never been the problem in general average 180-200)
Good/HDL: 48 (up 14 points from pre low carb 39 which is good but we thought it would be better) (it has never budged from the low 30's we thought 39 was an improvement)
So if to get the LDL you subtract HDL from total (is this correct?)
Bad/LDL: 212 (up 84 points from pre low carb 128)
Triglycerides: 171 (up 27 from 144 pre low carb) (I REALLY thought he'd be under 100) (Triglycerides have always been an issue for him 150-250.)
I put these numbers through the ratio calculators from some links here and most of the ratios seem a lot worse now.
We just really need some advice and encouragement. We are both commited to low carbing and appreciate all it's done for both of us, but we need to make it work without causing the worse lipid profile.
So some advice is needed-should he cut back on the saturated fat (butter, heavy cream) and maybe stick to olive oil? What about eggs. I really believed the science behind not worrying about consumption when under 50 net grams a day was sound so I'm wondering what we should do here?
His doctor now wants him on a statin which we are both against. Any thoughts for or against statins?
The nurse said 40mg of Zocor (and by the way BEFORE his new bloodwork our insurance had the nerve to contact the doctor based on the Sept 12 bloodwork with a total of 160 cholesterol ask her to explain why he wasn't on a statin!).
And she (the nurse) goes, "We don't want him to have a stroke." If I had my wits about me I would have asked how his cholesterol would cause him to have a blood clot or blood pressure (and his bp was 102/78 that day) that would cause a stroke.
Am I missing something here? I wished I had remembered the details of the study in Taube's book about higher stroke risk in Japanese men with too low of cholesterol.
The doc (who is a good doctor we think) told him the other day before this that a statin would cause muscle pain (as it did for several people we've known) when I expressed this concern to the nurse she said they had many patients on statins and acted VERY snotty about it.
He has worked so hard to improve and this just feels like such a blow.
Can stress and illness raise/mess with lipids? His mother passed away last week and so we were dealing with that (bloodwork a few days after she passed and he's super stressed over it)
And he was put on antibiotics (doxycilline) for a tick bite that was still struggling to heal 8 weeks later (and even as a diabetic he normally heals very fast) and that based on the type of tick, wildlife around us, the way it looked and his swollen groin lymph node-that he may have had a mild case of type b ulcer/glandulat rabbit fever/teluremia. (She did not biposy the bite or order special bloodwork.) The node is going down and some improvement in the bite about 1/2 way through the antibiotics.
Hubby is 59 and diabetic with well controlled high blood pressure (I think he's over medicated (1 10mg lotensisn). When his sugar was higher was when he would hit 130 and rarely 140 on the top bp number. Now his average is 105-110. At the doctor it was 102/78 and the doctor had to ask why and if he was tired or dizzy (which he wasn't) but yet she didn't offer to half his bp pill, which he started at the same time as his diabetes diagnosis.
Hubby was diagnosed in Sep 2012 with diabetes and an A1C of 7.8. Through 1000mg metformin and low carbing (most of the improvement seems to be from low carbing) his A1c is down to 5.6 and we hope to get it down even further.
His only truly bad numbers are his fasting/morning of 110-120, which we can't seem to get down no mater what we do. His post meal numbers are usually 90% of the time 95-108, at worst 110-115. (Pre-meal 90-100) (Wonder if our meter reads low or we are missing some highs?) (He can't take basal insulin due to his CDL, or otherwise we'd try it to get a better fasting number.)
His liver enzymes were elevated in Sept 12 and they thought he had fatty liver from Sept to Jan 13 they dropped in half (don't have the new ones) from the low 50's to mid 20's.
His kidney function GFR went from 74 to 84, so clearly the sugar being better and the diet was helping. (Again don't have the new ones.)
From Sept 12-Jan 13 his weight went down from 235-200 and he's now at 195-197. He's 6'1 so this is out of the BMI, but he's built like a football player and now has no visible fat and is starting to get the beginnings of a very toned/washboard stomach because he's muscular and the fat isn't there anymore.
When we started out we were doing Dr. Richard Bernstein's plan (I have nothing but respect for the man and think he's a genius.) But we found it a bit too restrictive at 6-6-12 carbs that weren't even true net carbs (only count 1/2 the fiber).
So we kind of did a mix of Atkins (but by the time I learned Atkins we were both 10 lbs from maintenance) and Ketogenic-staying under 50 net a day (though sometimes I think we might have gone over a little but I doubt we ever hit 75 much less 100 net carbs a day).
We do keep breakfast at under 6 usually about 3 carbs, and lunch is about 6-10, and supper 12-15 and dessert 6-8 but we don't go over 50 a day including snacks and beverages.
We don't cheat (yes I'm sure he doesn't and I'm so proud of him), we both get it's for life and have found substitutions (safe low carb ones) for many of the things we love and have both accepted that this is just the way it is from now on.
But we both know we've benefited from it in blood sugar, BP level (mine is now normal too it wasn't bad but was creping up), and we've both lost about 26 lbs (I was 5'2 and 126, now about my high school weight of 95 but in a size 6 not 0 pants.) and some of our friends think we both look TOO thin, but we know we don't.
It was a VERY hard and emotional adjustment for us both to make. We are both fully committed to it for life but this is kind of giving me my first doubts. The science is so strong behind it from what I've read (Taubes, Atkins, Phinney & Volk, Jenny Ruhl, Dr. Bernstein, etc...) so I need some help to figure out what we are doing wrong.
I know Dr. Bernstein says check thyroid if the lipids are off. The doc did TSH (which I now know is useless and mine through ZRT blood spot is a bit lower than his and my free T3 is low and my free T4 lowish and I'm now treating with thyrogold with info from sopthethyroidmadness site for probably hypopituatary)
His TSH was 1.690 (range 0.450-4.5) T4 (it just said this not free T4) 7.4 (range 4.5-12). No antibodies tests. Do you think maybe we should do the blood spot thyroid panel still? I wonder if he could be having T4/T3 conversion issues as I do?
I have a mix of high/low cortisol (saliva 4x a day test) and am treating it with Seriphos and I'm sleeping better. I'm wondering if cortisol issues could be affecting his lipds? He hasn't been tested.
He isn't exercising like he should. But part of that is because he is just too tired with his job which is a mix of driving and some pretty physical labor and moving of heavy things. They suggested exercise would help. Thoughts?
As to diet...I think he's using too much heavy whipping cream in his coffee. What do you think? As I got into maintenance I found that it did help me feel better to have a tablespoon or two in a cup of tea about 3-4 times a day. I think he's doing about 2T (he doesn't measure as I've asked) 6 times a day in coffee. I'm wondering if it's too much fat or too many carbs.
So here's what I'm thinking our options are. Please give any thoughts or advice.
-Since his blood sugar is pretty good but not ideal and Dr. Bernstein thinks (from what I've read) that could cause the higher lipids-say go on Atkins (new Atkins) at 20 strictly counted net carbs per the normal program and see if it helps the sugar get closer to the goal of Dr. Bernsteins 85. Thoughts?
We both kind of looked at it that if we could stay ketogenic at 50 net or under a day and have just slightly elevated as per the numbers above sugar-mine is 90-105 tops at all times-it would be worth it to make it sustainable for life.
Do you think lowering his blood sugar more through restricting carbs would help?
We cook in olive oil (always have) and with the other fats being heavy cream and dairy (I never used butter until now at all-we used to be very low fat with ice cream as the only indulgence) I am kind of stunned his good cholesterol only went up 14 points from 39 to 48 from Sept 12 (low fat) to now June 13 ten months into the diet.
He looks think (not just be comparison) but by looking at him. It would be hard to imagine how he could loose any more weight and it not be muscle (which we did loose because at first we didn't understand about keeping the protein count sufficient) because his stomach looks pretty much flat and well defined now.
We really want to stay low carb and certainly 50 or under. But how do we do it if the fat (if it's the fat he's eating?) is causing his lipids to go up in a mostly negative way. And from the science I just don't think it should unless his body just can't tolerate them or something.
We view it this way...we KNOW what will happen to him if he lets his sugar go up and eats high carb But we don't know (even though the doctor tries to say it) what will happen with his cholesterol levels what they will do.
I've read Eades and Taubes, etc and it seems 230 total seems to be the point you need to take action and stay below and at 260 total he's above that. I wouldn't be as worried if it were mostly good/LDL, but it's not.
We just need some help here...any thoughts would be appreciated
1) that is not how LDL is calculated. and any way of calculating it is just a guess, and a bad guess for a low carber. please ask doctor for a DIRECT LDL test (this is an absolute minimum if they are going to try to medicate you for this stuff) and a VAP test. The VAP test is less common, but it shows whether this LDL he's got is the bad small dense kind or the harmless large fluffy kind. For most low carbers it's the second and not something to worry about. it's important to know the difference, though whether his doctor is up on this stuff enough to know how to interpret the VAP is another matter.
2) Is he a man under 65 with one or more previous "heart incidents" like a heart attack? read the BloodSugar101 site on the use of statins, but my understanding is that this is the only group that actually gets health benefits from them. otherwise the numbers go down, but the people still die of heart attacks at the same rate. it's some sort of false lowering which is not really beneficial. my friend who is a pharmacologist (the people who develop drugs) says he and his friends in the field all pretty much refuse to take them. they have bad side problems and are not really as beneficial as the doctors like to think.
3) don't worry about the fasting blood glucose if all post prandials and A1c are good. it's not that big a deal. they only focus on that because it's an easy way to identify problems--someone with high fasting normally has SKY high later and they need to investigate. there is no particular magic in your reading at that time as opposed to other times. does he take some Metformin at night? that could help if he doesn't.
4) what fat to eat is a complicated question. I agree that what we have heard suggests his low carbing makes the saturated fat ok, but who knows?
is there any way he can learn to put coconut oil instead of cream in his coffee? I think that might improve his lipid results. it takes some "wrapping your mind around it" because we are used to it getting LIGHT, but the fat in one acts pretty much like the fat in the other in the coffee.
5) exercise is a good thing, for sure. can he just find little ways to walk more during the day?
6) I don't know enough about most of your other questions to comment. I found when I had VERY low Vitamin D that getting it back in the normal range helped a lot of stuff, so you might ask for that to be tested too.
good luck to both of you. don't give up. *hug*
Another thought is coconut milk in his coffee.
Nice reply Raven:)
high cholesterol is not a measure of illness. Unless he has other indicators that he is in danger of cardiovascular disease, the cholesterol numbers are just an indicator of how much cholesterol his body is making.
The amount of cholesterol your body produces is indirectly linked to how much cholesterol you eat, in fact it is usually an inverse relationship. The more you eat the less your body produces, and the less cholesterol you eat the more your body will produce to keep a balance that it has set for the body. It's not the diet directly that causes a raising or lowering of cholesterol but how the body is reacting to circumstances that may have been changed because the diet has changed.
For example, When your body is storing fat, there will not be a lot of FFA in the blood stream because it is being swept up and stored. That might seem like a good thing, except that you are storing fat. By having the fat available in the blood stream it can be used. An analogy would be saying that you can reduce car accidents by removing cars from the roads, but then you cannot use the cars for anything. Better to make the roads better and the drivers better so that cars can safely be on the road.
Populations with high cholesterol don't necessarily have "bad health". Getting his cortisol checked would be a good idea. Since cholesterol is so important especially for older people, you want to make sure that there are not other factors harming his body that is increasing the need for cholesterol for repair, which is one of the functions of cholesterol as well as hormonal regulation.
I agree with Raven. If they want to medicate him, then they should be willing to get more conclusive tests. Checking for markers for cardiovascular, checking his LDL lipid type, cortisol tests. Keeping his blood sugar in check and avoiding other high oxidating risk behaviors like drinking, smoking, excessive medicines with side effects, tanning.
Exercise I think is important because it makes the body a more efficient user of energy and better and faster at repair and upkeep. I read that low oxidative exercises, ones that don't raise cortisol a lot like aerobics and running, like weight bearing, muscle building, or High intensity intervals, would help improve body health without adding a lot of stress, especially if he's already tired. I've had my eye on slow burn, and I love it ( when I do it :rolleyes:)
Good luck in figuring things out. Don't be afraid to ask for more information from your doc and if they don't know they are good docs if they refer you to someone who CAN answer your questions.
The good news is that his bp and blood sugar are doing great. You can't over state how important that is....so pat yourselves on the back, your doing something right.
The lipid stuff is not all bad news. How did you ever raise the HDL to 48 from 39?
I would love to be able to do that. I've been stuck at 39 for years, and even though I lost 50 pounds and have been exercising regularly that is the one number I can't seem to raise.
The latest research seems to suggest that trigs are the more important indicator of risk. So that is the number I'm most concerened about....but according to my doc, who I think is great the ratios are really important too.
Still, I wish I could get that HDL level up.
We were eating very low fat before. Very Asian with lots of rice, moderate veggies and little meat. We did always cook with a lot of olive oil and use it on food and popcorn (all pre-low carb, obviously no rice or popcorn now). He took fish oil capsules then as he does now, and still had the low HDL.
I'm not sure but I think it was the adding of the butter and heavy cream (in coffee and as whipped cream as a garnish to low carb ice cream) to his diet that raised the HDL (but also the LDL too I think). We were happy it raised but disappointed it didn't raise further. We still cooked in olive oil and added it to veggies, etc...
I've got a ZRT thyroid panel (blood spot) test ordered for him since his doctor will only do TSH and T4 (not free type) and I'm hoping that maybe a thyroid issue is to blame for the wonky cholesterol numbers.
I've done some reading since I posted...and I'm wondering if part of the raise in LDL was a fatty liver (which he likely had, but no formal diagnosis) clearing/cleansing itself and it going into the blood stream as it cleared his system. The Weston Price foundation had an article about it, which I should have saved the link to.
We're not going to let him be bullied into a Statin by the doc or the insurance company. But obviously have to figure out why it's too high. Hoping the thyroid issue (likely based on symptoms & body temp) will make a difference.
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