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I am a New Zealand registered nurse and nutritionist (Grad Cert Sci: nutrition, Massey Univ). I am a Certified Zone Instructor, and have worked teaching Zone diet principles to hundreds of clients over the last 10 years. More recently after finding that eating Paleo food choices was the "icing on the cake" health wise, I have become a Paleo enthusiast and teacher. Follow me on twitter @juliannejtaylor

Why I won’t take statins for my high cholesterol

The latest New Zealand Listener magazine has a feature article on statin drugs, I feature saying I wouldn’t touch them personally – here is why:

When my total cholesterol hit 10 about 18 months ago it gave me a fright. My LDL was up to 7.5 mmol/L. My HDL is around 2 and my triglycerides around 0.8, by all accounts fantastic. Yes – this test is calculated – that means it is not directly measured, however through Imupro I got a direct LDL measure and it was still high, predominantly large fluffy, with some small dense, and there was oxidised LDL to boot – that is not good.

My LDL has been a bit high for some time, but nothing like this – mostly since menopause and becoming hypothyroid due to my Hashimotos – auto-immune thyroid disease. I’m on levothyroxine. I feel normal and have no hypothyroid symptoms, my thyroid tests are normal now, although anti-bodies remain elevated.

The doctor wanted to put me on statins. I told her I would research diet and supplements and try getting it down that way. I refuse to go on statins. I value my brain and my strength (statins have an effect on both for many). For women without prior heart disease the chance of statins reducing the risk of death is close to zero. The chances are greater of having side effects like getting type 2 diabetes.

So here are some current stats for me:

  • My age: 54 at this time – 2 years post menopause
  • Blood pressure 110 / 65 (very good)
  • Blood sugar – both fasting and HbA1C are in the non diabetic, non pre-diabetic range
  • BMI 22 (that is in a very healthy range)
  • Body fat – around 25 – 28 % (could be lower, but healthy for a female)
  • Waist – a measure of visceral fat  is 28″ or 71 cm, a healthy waist is half your height or less so for me that is 30.75″ or less
  • Fitness – At that time my exercise level had decreased as I was doing a lot of study
  • My stress was probably a bit higher than was healthy – dealing with a difficult teen and studying post grad.
  • My actual calculated risk of having a heart attack in the next 10 years is 1.8% (You can work yours out here – click on customise this NNT)

Why is my LDL so high?  – well this gave me a clue – Dr Nadowsky has been seeing patients on a paleo diet who have been regularly consuming Bulletproof coffee with extremely elevated LDL cholesterol. ‘Bulletproof’ Coffee May Hike Lipids.

Franziska Spritzler a registered dietician wrote about her elevated LDL on a high fat low carb diet:   Lipid Changes on a Very-Low-Carb Ketogenic Diet: My Own Experience

Paul Jaminet wrote about high LDL frequently seen in low carb paleo dieters: Low Carb Paleo, and LDL is Soaring – Help! And here is the follow up post: Answer Day: What Causes High LDL on Low-Carb Paleo?

I was having coconut oil in my coffee and hot cocoa, not a huge amount but it probably added up to almost a cup a day, and I was liberal with butter. My carbohydrates were quite low, on a paleo diet it is almost impossible to eat even a moderate carb diet when you eat mostly non starch vegetables and only a little fruit.

Time to make changes: I cut my fatty meat, went lean, cut out butter and coconut cream and added more starches to my diet.  I went to at least 100 grams of carbs a day – previously I was eating around 50 – 80 grams. I eat a lot more kumara, pumpkin, sweet potato.

I’ve made some supplements changes. I’ve dropped the fish oil supplement – I was taking fermented codliver oil, I only take  Sears OmegaRx now. I also reduced the amount of Omega 3 supplement as polyunsaturated oils oxidise easily. (I seem to need some supplement on top of eating fish to feel my best) OmegaRx is batch tested to show it has no oxidation and. Fermented codliver oil tastes oxidised – I just don’t trust that this is safe.

I added some vit C plus bioflavanoids, plus vitamin E tocotrienol an LDL anti-oxidant. I added curcumin as well as it can help reduce LDL, plus took some selenium and zinc to optimise my thyroid conversion of T4 to T3. I have Hashimotos which  can increase LDL because LDL receptors are down regulated and it doesn’t clear so well from the bloodstream.

I increased my exercise – with more weights and more bouts of high intensity sprints, plus regular walks. (I can now easily back squat my body weight and dead-lift 1.5 my body weight)

My meals are primarily lots of vegetables and a palm size of lean protein or 2 eggs. I add little fat – if I do it is whole nuts, olive oil or avocado. Satiety is great – I get full and don’t need more that 3 meals a day. And no, I did not put on weight with more carbs, on the contrary I lost weight and more importantly for me – some fat off my waist.

Sleep is better on more carbs, and alcohol desire is less interestingly. Some hypothesise  that alcohol cravings increase if carbs are too low for you.

When I tested my cholesterol the next time – my LDL had reduced to around 4 and my ratio of  total to HDL cholesterol had improved to a healthy ratio. My C-reactive protein – a measure of inflammation which I also got tested at this time was 1 – a low level.

So – if you like me have increased LDL on a low carb, high saturated fat paleo diet – try increasing you paleo carbs and swapping out coconut oil and butter for olive oil, avocado and nuts.

Is there a place for statin or cholesterol lowering drugs?

When I said I wouldn’t touch them with a barge pole, that does not mean that you shouldn’t if there is a benefit. You need to weigh up the odds and discuss with your doctor and make your own decision. For those with known heart disease here are the numbers needed to treat figures:

In Summary, for those who took the statin for 5 years (with known heart disease):

Benefits in NNT

  • 1 in 83 were helped (life saved)
  • 1 in 39 were helped (preventing non-fatal heart attack)
  • 1 in 125 were helped (preventing stroke)

Harms in NNH

  • 1 in 100 were harmed (develop diabetes*)
  • 1 in 10 were harmed (muscle damage)

If you have had a heart attack and change your diet to a Mediterranean diet – you will get far more benefit than Statin drugs:

In Summary, for those who adhered to the Mediterranean diet:

Benefits in NNT

  • 1 in 18 were helped (preventing repeat heart attack)
  • 1 in 30 were helped (preventing death)
  • 1 in 30 were helped (preventing cancer)

Harms in NNH

  • None were harmed

And if you want to prevent heart disease the Mediterranean diet is also far more effective than statin drugs:

In Summary, for those who ate the Mediterranean diet:

Benefits in NNT

  • 1 in 61 were helped (avoiding a stroke, heart attack, or death)

Harms in NNH

  • None were harmed (diet effects)

To gain a better understanding of what NNT means – this is an excellent talk:

Truth That Lasts: David Newman

 

 

 

 

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21 Responses to “Why I won’t take statins for my high cholesterol”

  1. Hi Julianne,

    This post needs to be shouted from rooftops with a megaphone! You’ve demonstrated how effective making only lifestyle changes can be.

    I get my fats from pork, sardines in tomato, eggs, full-fat cheeses, full-fat milk and nuts. I don’t add any extra fats like butter, EVOO or VCO.

    I get my carbs from veggies, whole fruits, the drinks that I make using juice, water & low-sugar carbonated drinks, the milk and the spoon of sugar that I add to my coffees. I’m probably consuming ~120g/day of various carbs.

    I’m the lowest weight that I’ve been for a very long time and a lower weight than the lowest weight I achieved on a very-low-carb diet. Whole foods, for the win.

    Regarding very-low-carb diets: Have you seen the lecture by Dr. Diana Schwarzbein at https://www.youtube.com/watch?v=rm0MG_zYIdQ? Any comments?

    Cheers, Nige

    October 10, 2015 at 12:23 am Reply
    • No – I haven’t watched that – but will. Interesting you are having success with lower fat higher carb. I think people forget how calorically dense fats are and volume wise veggies fill you up. Also genetically some do better on more carbs and less fat. It might depend on the amylase you have and how many copies of that gene you have which may determine your starch tolerance and digestion http://genetics.thetech.org/original_news/news62

      October 10, 2015 at 10:17 am Reply
  2. charles grashow #

    So – what is your diet like now?

    October 10, 2015 at 2:56 am Reply
    • I eat a lot of seafood, I have about a palm of lean protein per meal, (about 100grams cooked say poultry or fish) About a cup of starch or fruit and a lot of non starch vegetables – leafy and above ground. Sometimes a meal will have the protein then a berry and green smoothie for the carbs.

      October 10, 2015 at 10:20 am Reply
      • charles grashow #

        Does this mean that you believe that high LDL and high TC constitute a problem

        October 10, 2015 at 11:03 am Reply
        • I think it can – especially if you have high particle numbers and oxidised LDL. Not willing to take the risk personally. My LDL is still between 4 and 5, so it is not low by any means, however I don’t think that I need to go very low to be safe either. I’m taking care of all risk factors, and I do have a family history of heart disease.

          October 10, 2015 at 11:31 am Reply
          • Name (Required) #

            Julianne, you’re getting really dishonest and tactful at this stage. You know damn well that LDL-p is a problem, yet you still promote and rationalize paleo guru’s that give advice that is almost certainly going to give them a high LDL particle number.

            Talking about oxidised LDL, are you aware of the process that lead’s to oxidised LDL? High blood LDL levels that stay in the plasma are the most obvious causes of oxidised LDL.

            October 18, 2015 at 11:34 pm
          • Yes – I am aware of that – hence I do not agree that high LDL is safe. Where have I said it was? I changed my diet in order to get it down. Can you tell me where I have been dishonest? And why can’t you be honest and use your real name instead of hiding out behind no name?

            February 29, 2016 at 10:21 am
          • charles grashow #

            Have you recently had your LDL-P and ApoB/A1 measured?

            October 19, 2015 at 8:23 am
          • No -I haven’t. They are not standard tests here in NZ, just looked them up and it appears they are available so will ask the doctor for an order for them

            October 19, 2015 at 12:24 pm
  3. Honora #

    Snap! Glad you posted on this, Julianne. I’ll read up the links. Thanks.

    My total cholesterol peaked at 8.2 and the other levels followed a similar pattern to yours with similar blood results and BMI. I’m on whole dessicated thyroid for the Hashimoto’s these days. Still working on getting the FT3 optimised.

    I dropped back on the saturated fats as well and the total cholesterol, LDL and risk ratio accordingly dropped but I’d like to get it down some more so will follow your advice about replacing the sat. fats some more with the monos. I need to get my CRP measured too.

    October 10, 2015 at 9:53 am Reply
  4. Nigel K. directed me to you site. Great post! I wonder if http://www.thennt.com/ will be able to look at the NNT using other diets? I find the NNT to be quite useful. I wish more physicians knew about it.

    October 15, 2015 at 4:33 am Reply
    • Thanks. Yes I wish too. I think my risk dropped from 1.8% to 1.5% if I were to take statins, a reduction of about 20% relative risk – sounds fantastic – but reduction of real risk is just 0.3% Big difference!

      October 15, 2015 at 1:43 pm Reply
      • Over what period of time is the RRR 0.3%?

        RRR increases approximately in proportion with increasing time period. People take statins for the rest of their lives, not 3.3 years (in the case of ASCOT-BPLA).

        October 17, 2015 at 7:30 am Reply
  5. Name (Required) #

    You still seem to be caught up in the paleo/low-carb/ancestral gibberish crowd that says “large fluffy” LDL’s are of no concern.

    That’s worrying, considering you’re giving health advice on the internet and profiting from it.

    October 18, 2015 at 11:47 pm Reply
    • charles grashow #

      Would be nice if you used a name.

      October 19, 2015 at 8:23 am Reply
    • I’m actually not caught up in that – where in my post did I say LDL-C if high was safe and not a concern, even if high large fluffy – I didn’t, I said mine was mostly large fluffy and you added that. Large fluffy is better than small dense, but excess LDL of any type not being cleared is an issue. I freaked when mine was high and I’m doing everything I can to bring it down into normal levels without statins. Oxidised LDL and LDL particle numbers add further levels of concern. I said you also need to look at the whole picture and add the other risk factors into the equation.

      October 19, 2015 at 8:29 am Reply
    • I don’t believe that too high LDL is safe. Large fluffy is better than small dense. But too much is still a problem

      February 29, 2016 at 10:22 am Reply
  6. Lisa #

    Thanks for the article. Informative and read worthy. Try this: http://tinyurl.com/hz6ualf
    It’s a Natural support for you cholesterol. The Hypercet cholesterol Formula acts as a general tonic supporting the cardiovascular system. Supports good and bad cholesterol levels within the normal range along with he ability to deal with harmful free radicals.

    February 8, 2016 at 7:10 am Reply
  7. Robert Siegel MD #

    Lovely use of biostatistics–thank you.
    A question–can you direct me to a reference for the NNH of 10 for statin-induced muscle damage? The clinical trial data I\’m familiar with reported that the NNH for statin myopathy is much higher, closer to 2000.

    February 28, 2016 at 4:03 am Reply

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