Retrospective #282: Total Cholesterol, LDL-C and Statin Therapy

I documented the phenomenal transformation of my triglycerides (TGs) and HDL cholesterol (HDL-C) over the last 35 years in Retrospective #281. Okay, mock me, but this obsessive record keeping does have redeeming value: it gives an objective picture of changes brought about by my diet. The changes started in 2002 when, on my doctor’s advice, I began to eat Very Low Carb to lose weight. He said, as we walked down the hall, “It might even help your diabetes.”

He was “right as rain,” of course. Besides eventually losing 170 pounds, I was able to stop taking almost all of my oral diabetes meds. My daily fasting blood sugars are now consistently under 100, something I hadn’t seen in the previous 16 years of eating a “balanced” diet and leaving my diabetes care to my doctor and prescription meds.  My A1c’s dropped to the mid 5s, my blood pressure improved from 130/90 to 110/70 on fewer meds, and my hsCRP, an inflammation marker, went from “high” to “low” risk of CVD. Finally, my lipid (Cholesterol) panel dramatically improved, specifically HDL-C and TGs, while my Total Cholesterol and LDL-C were stable.

Figure #4, shows a composite history of my HDL-C and TG values over this 35-year odyssey.

About a year after starting to eat Very Low Carb, although already 60 pounds lighter, my doctor started me on a high dose statin. It was warranted, he said, by the guidelines. I was both a long-time Type 2 (since 1986), and I was, he said, at “high” risk for cardiovascular disease. And I was still morbidly obese.

As Figure #5 shows, the statin “worked” in the sense that it lowered both my Total Cholesterol (TC) and LDL Cholesterol (LDL-C) dramatically. Note that before starting on a statin, my TC and LDL-C were “borderline” and “slightly high” respectively. Thirty-two TCs averaged 195 and twenty-eight LDLs averaged 131. These are both “typical” for people who have been eating the Standard American or “Western” Diet for a long time. But for diagnosed Type 2s, who are at higher risk of CVD, an LDL target <100 is recommended. For Type 2s with diagnosed CVD, the goal is <70.

During the five years (12/03 – 10/08) that I took a statin, my TC averaged 125 and my LDL averaged 58 (average of 20 lab tests). You might fairly conclude that the statin worked perhaps too well. Meantime, On Richard K. Bernstein’s 6-12-12 diabetes diet, a Very Low Carb program I began in September 2006, I had lost another 100 pounds in under a year. As a consequence of eating VLC, over the course of 5 years, I had lost 170 pounds, my blood pressure had dropped to below goal, my HDL had more than doubled and my triglycerides had dropped by more than two-thirds.

So, after all my risk factors had improved so dramatically, and all had stabilized, after 10 more months now on low-dose simvastatin, my DOCTOR suggested that I STOP taking statins. Again, see Retrospective #9, “Metabolic Syndrome,” and Retrospective #25, “Understanding You Lipid Panel,” to understand his rationale.

After stopping the statin, my TC increased to 214 and my LDL increased to 125 (average of 19 tests), versus 195 and 131 before.  But while both are still “borderline” by the standard, neither is now of any concern to my doctor. Nor should they be, because of my greatly improved HDL-C and triglycerides. Remember, the old Friedewald formula for calculating LDL: LDL = TC - HDL - TG/5. In 2018, Quest switched to Martin/Hopkins which produces a higher LDL for most people (but not for me, due to my very low triglycerides). PS: If you have a high calculated LDL, it may be due to your high triglycerides. Request a direct measurement to confirm it, OR eat Very Low Carb to lower your triglycerides.

We will also describe some hypotheses and recent scientific studies regarding using triglycerides alone to track and monitor CVD risk…which brings me back to Figure #4 in this post (above) and to Figure #3 in Retrospective #281. If you are persuaded by these data and want to lower your triglycerides (and raise your HDL-C, since they are, as I have shown, inversely related), then I hope you will consider eating Very Low Carb with fish oil supplementation, and of course eating a can of delicious Brisling sardines in extra virgin olive oil (EVOO) for lunch every day, as I did. LOL.