Sunday, October 14, 2012

The Nutrition Debate #70: LDL Cholesterol and Statins

My doctor is hinting that I should start taking statins again. Knowing that I know a little something about lipid health, and that I have “taken charge” (in a sense) of my own healthcare, I expect he knows he has to tread softly with me on the subject of statins. He also knows that I respect his knowledge (he is an internist and cardiologist), and he has worked well with me for over 20 years.
After failing to get me to lose weight on a balanced diet, under his nutritionist’s supervision, in August 2002 my doctor suggested I try Atkins. It worked. In 9 months I lost 60 pounds, and a few years later after gaining back 12 pounds I started on Bernstein and lost 100 more in less than a year and then later another 22 (170 total). Upon starting Atkins I immediately needed to greatly reduce and/or eliminate all three classes of oral diabetes medications I had been taking. (I have been a Type 2 diabetic for 26 years.) By my lowest weight my blood pressure had also gone from 130/90 to 110/70 on the same BP meds.
In addition, my lipid health completely turned around. My HDL Cholesterol more than doubled from 39 to 81 (averages), and my triglyceride averages went from 137 to 49. (For details of the HDL story go here and for the triglycerides go here.) But, you may ask, how did my LDL Cholesterol fare during this transformational period? At a glance it appears to me that it did pretty well, but bear in mind that LDL Cholesterol is a calculated number (not an assayed value). Also, statins lower LDL very effectively.
Between 1992 and August 2002, when my doctor suggested I try Atkins, my LDL had been tested 12 times. The average was 142mg/dl. For reference, from 130 to 159mg/dl LDL is considered “borderline high.”Over the next 16 months, while I was on the Atkins diet and losing weight, it was tested 16 more times, and the average was 125. The clinical guidelines consider under 130 “near/above optimal.”  But, for patients who have either hypertension, Type 2 diabetes or are obese, the guidelines suggest <100, and if the patient presents with more than one of these conditions, the guidelines are <70mg/dl.
So, since I was obese, hypertensive and a Type2 diabetic, in December 2003 my doctor suggested I start on a statin: I started on 80mg of Lipitor, as I recall, and it definitely lowered my LDL Cholesterol. Over the next 5 years the average of the 21 LDLs taken was 60! I was lucky. I had no side effects that I can recall (but maybe cognition was one of them – LOL). And, soon after starting them I switched to a generic (Simvastatin,) and over a period of time took less and less until my doctor finally took me off them completely in December 2008.
Since that time my LDL has been tested 11 times for an average of 123, and that includes the last two: 146 and 149. This 123 average is virtually the same average as my first year on Atkins (125). It is also under the 130 “near/above optimal” value, and I still weigh today more than 100 pounds less than when I started Atkins.
However, my weight, blood pressure, fasting blood sugars and A1c’s have been creeping up a bit recently. So I find myself at a crossroads: Either I stick closely to my Very Low Carb Restricted Calorie diet (as I have been for the last 6 weeks) to lose weight, improve my BP, A1c and LDL Cholesterol, or I start to take a low dose statin again (for the LDL only). My doctor wants me to look into pitavastatin. So I did. It did well recently in a prospective, randomized, double blind, double-dummy trial reported on here. A minimum dose of 2mg had a 39% reduction of LDL compared to a 35% reduction of LDL for a minimum 20mg dose of Simvastatin. I didn’t check out the side effects or “adverse incidents.”
I think my approach (should the subject arise at my next office visit) will be to say “no” to starting on a statin again so long as I am making improvements in my weight, BP, A1c and LDL Cholesterol. (See, your subtle approach worked, doc.) If I can consistently keep my LDL between 100 and 130 without a statin, and lose weight again, and improve my BP and A1c and FBG entirely through my Very Low Carb Restricted Calorie diet, I think I can keep the doctor off my back. Let’s see, after he reads this, if he will agree with this plan.
© Dan Brown 10/14/12

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