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: