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11 Responses

  1. bsc
    bsc September 21, 2011 at 6:32 am | | Reply

    Early in my diabetic career, I believed my doctors and took statins and other cholesterol lowering drugs. What a huge mistake, I survived, but the whole episode put my life in danger. As I read more about the dietary fat, cholesterol and heart disease theory I became dismayed at the situation. There is poor science behind these theories, dietary fat does not just “raise” cholesterol and cholesterol does not “cause” hardening of the arteries. Huge amounts of money have been spent with studies trying to prove these theories and they have failed. Gary Taubes wrote about this in his landmark book “Good Calories, Bad Calories.”

    Following the NCEP advice, my triglycerides soared on a high carb diet and my HDL “tanked.” Today, I follow a low carb high fat diet to lower my triglycerides and keep my cholesterol profile healthy (not low). I choose lots of healthy fats and have triglycerides and HDL well within target.

    Be a smart patient. Read about this on your own. Ask questions of your doctor. Don’t simply trust all medical advice. As diabetics, we always must take personal responsibility for our own health and that goes for diet and cholesterol.

  2. Scully
    Scully September 21, 2011 at 6:58 am | | Reply

    Thank you for posting this. I have been struggling to understand why my cholesterol is so high yet my lifestyle should prove the exact opposite. So I appreciate the information here that is hard to really nail down by surfing the net. This was really informative.

  3. Michael Ratrie
    Michael Ratrie September 21, 2011 at 7:08 am | | Reply

    Dr. Om Ganda has it right, of course. Having all diabetics take statins is one of those generalities that demands questions.

    My primary care doctor wanted me to take them simply because I was a diabetic. When I pushed back and he actually looked at my LDL, he frowned and said, “You’re right, your LDL is too low for a statin.”

    bsc has it right as well – “Be a smart patient”

    Cheers,
    Mike

  4. Bernard Farrell
    Bernard Farrell September 21, 2011 at 9:24 am | | Reply

    I’ve seen what a difference exercises makes in LDL and cholesterol values. Last year my LDL was 101 and my cholesterol (with Lipitor) was 175. This year I’ve been exercising much more frequently and my LDL is 79 (20% reduction), cholesterol is 157 (10% reduction).

    Apart from making me feel and sleep better, exercise is key in helping get these numbers into range. Make time for yourself and exercise.

  5. Casabby
    Casabby September 21, 2011 at 12:06 pm | | Reply

    I second the remark about not putting all people with diabetes into the same category. Insulin resistance, high cholesterol, high blood pressure and heart disease seem to come as a package for many people with Type 2. Type 1 results because of an autoimmune attack on the beta cells. Although heart disease can result from poor control of blood sugars, it is a complication of Type 1 not an integral part of the disease process. Obviously anyone with Type 1 can get high cholesterol just like any other person, but it’s because of genetics, poor diet, lack of exercise, etc. It’s not because one has Type 1.

    They need to do more heart studies on patients with Type 1 (especially well-controlled Type 1) rather than grouping us with Type 2 patients. Our diseases are different and our risks are different.

  6. Noah
    Noah September 21, 2011 at 4:11 pm | | Reply

    When I was diagnosed with Type-2 diabetes at the end of last year, my total cholesterol was well over 400 and triglycerides over 4000 (yep). The crazy high triglycerides meant they couldn’t determine the levels of the major cholesterol types. A few weeks later, when my triglycerides were low enough to get more detail on the cholesterol, my VLDL was almost 50 and HDL was in the low 20s. The cardiologist (whom I got sent to because of the triglyceride levels and occasional chest pains), had a conversation with me about the direct link between dietary carbohydrate intake and triglyceride levels (in addition to blood glucose). My regular doctor also provided lots of research material (I’m a huge science geek, both professionally and in my non-working life).

    After that, I progressively cut out the most sources of carbohydrates from my diet (using pre and post meal blood glucose tests to fine tune what sources caused the largest blood sugar spikes). These days, I consume a diet high in fats (including saturated fats like ghee and coconut oil), moderately high in protein and low in carbohydrates. I also, very gradually, added exercise into the equation, ramping up from a couple of 10 minute walks each day (about the maximum I could sustain) to ~60min/day combined with resistance training 3 x week.

    Since the end of spring, I’ve had two lipid profiles done, and am maintaining triglycerides in the 90-100 range, VLDL below 20, LDL 70-90 and HDL is over 40 and rising. I’ve never had lipid numbers this good.

  7. riva
    riva September 21, 2011 at 5:27 pm | | Reply

    The latest thinking on cholesterol is what matters more than your LDL number is the size of your LDL “bad” particles. Big, fluffy particles are good since they travel through the blood vessels, small particles are bad since they tend to be sticky and stick to each other and build up and form a blockage to the heart. I don’t know if you need a separate test to know the size of your particles but it’s something to find out.

    My LDL the past few years is always slightly over 100, like 107. But my HDL is also over 100, like 108. That 1:1 ratio means even tho my LDL is over 100 no statins needed here. Yet, my GP wanted to put me on them for years and I refused. I did my homework. BTW, I’m convinced my high HDL is from eating so many vegetables every day at lunch and dinner, in addition to a healthy diet and regular exercise.

  8. Natalie
    Natalie September 21, 2011 at 5:38 pm | | Reply

    It isn’t the saturated fats that cause high triglycerides and VLDL (which are probably more damaging than LDL itself), it’s the carbs. ALL diabetics, including Type 1′s, have peripheral hyperinsulinemia, either because we produce too much, or we shoot our insulin into the skin, whereas natural insulin goes from the pancreas straight to the liver, which uses up to 90% of it. So, no, there is no difference between the types on this one. Type 1′s die of heart disease and strokes just as much as Type 2′s do.

    I attended 2 presentations at AADE, both of which came to the conclusion that it’s fructose and added sugar that cause artery disease. Fructose is immediately converted in the liver to triglycerides and VLDL. That’s certainly part of the picture, because sucrose, as added sugar, is half fructose. Even excess glucose, as in when you’re high, is converted into triglycerides and VLDL. That’s why doctors assume that all diabetics have high cholesterol, because they assume that everyone is as poorly controlled as they were historically.

    But the other part, as stated in the column, is hyperinsulinemia. The less insulin you need to take, the less peripheral hyperinsulinemia. Stands to reason. And the best ways to lower your insulin intake are, exercise, as you mentioned AND limiting carbs as much as possible. There are no nutrients in grains, potatoes or fruits that can’t be gotten in vegetables. So there is really no reason to eat them, other than as occasional treats. And you can eat all the vegetables you want! :-)

    As far as statins, there is a risk/benefit ratio. If you clearly have problems with triglycerides, VLDL and LDL, and diet and exercise don’t work, then statins might be worth a try. Again, this is not restricted by Type, but by the metabolism you were born with. There are insulin-resistant Type 1′s AND insulin-sensitive, so-called Type 2′s (who are actually NOT classic Type 2, but have other metabolic issues which simply haven’t been described, and no antibodies, so they are thrown into the Type 2 garbage can). Many people do just fine on statins, with no side effects for decades, and for them, why not? If you happen to be the one with side effects, you can always stop. There is simply no black and white answer to this one.

  9. Sysy
    Sysy September 22, 2011 at 6:16 am | | Reply

    When I went from high to lower carb diet with lots of vegetables, my lipid profile normalized. The last piece of the puzzle for me was triglycerides-those normalized once I lowered my A1c to 5-6% range. I can’t believe I used to have really high cholesterol. Those days are hopefully long gone.

  10. Lillian
    Lillian September 22, 2011 at 9:48 am | | Reply

    You mention ‘Eat foods with low cholesterol’ but you don’t spell out what good examples of those might be.

    To make it easy, all animal products (not just meat, chicken, and fish, but also milk, butter, other dairy, and eggs) contain cholesterol. Further, only animal products contain cholesterol. There’s no cholesterol in fruits, vegetables, whole grains, or anything else that never had a mom.

    Individuals’ inherent levels of cholesterol will vary, but instead of looking to drugs with side effects as a solution, why not just cut down on eating animal products? The only side effect is better health.

  11. Heather
    Heather September 23, 2011 at 5:44 am | | Reply

    Our 13 year old T1 son was prescribed a statin 14 months ago due to an LDL level of 119. After much discussion with other medical professionals and much time spent in consideration of the real risks we opted to revisit the idea of a statin in several years rather than expose a child to a dangerous medication with no real knowledge of the long term consequences. Our thinking was that increased risk of heart disease is not the same thing as having heart disease and the long term unknowns of giving statins to a growing child are not worth playing with. Our Endo was pretty pushy about it but we were increasingly convinced that our course was best for our son. So imagine our surprise when we learned that his LDL level is probably not really that high. It turns out that most cholesterol tests use a calculation to estimate your LDL levels because a separate test that really does measure LDL is time consuming and expensive. The Friedewald calculation says LDL = total cholesterol – HDL – (triglycerides/5). However the calculation is thrown off by high or low triglyceride levels. So if your triglycerides are below 40, as our son’s are, or above 400, you would need a specific LDL test to accurately measure your LDL. With that in mind I find it suspicious that statins are so frequently offered as a first line of defense against heart disease and stunned that they would be suggested for children. Whether their known side effects concern you or not, they definitely have not been around long enough for long term results to be determined. So why wouldn’t every patient insist on an accurate testing of their LDL level before embarking on a dangerous drug? My guess is that, like my family, they have no idea their LDL hasn’t really been measured.

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