The FastDay Forum

I'm still studying cholesterol, as I need an explanation with my LDL standing at 6.0! ( now found it, and quite happy)
Thanks to Ballerina I have now re-read Dr Malcolm Kendrick's views regarding the Cholesterol Myth, and it is mind-blowing stuff, considering how many prescriptions are handed out for statins. My GP dismissed my concerns when I first read the book.
My question, which I keep asking, is " how come our GP's don't read this stuff, and if they do, why do they not reflect it in their practice?'
As Dr Kendrick points out, it is because the whole bad science thing has just grown far too big, so it is easier to vilify supporters of the con, as equivalent to flat earthers.

Current NHS / NICE guidelines are as simple as "if cholesterol > x then prescribe statins". The GP wouldn't want to be sued by your dependants if he didn't follow these and you keeled over from a heart attack.

I joked with my GP that I had a cholesterol test at a pharmacy, but I wasn't going to tell him the results in case he diagnosed a statin deficiency. (Total was 5.05 FWIW).

[carorees]

My total cholesterol was rather high too, but as my HDL was also high (ratio 3.5), the GP was OK with it (after I showed her the paper in the Lancet showing that the TC:HDL ratio is the best predictor of risk). I'm fairly sure that once we are 'fat adapted' (i.e. on a low carb diet/used to fasting) our cholesterol levels are higher than the 'average Joe' because we need fat circulating in order to use it for energy. The average person eats carbs so regularly that they never need to burn much fat and so their cholesterol levels are lower.

Caroline, how can you explain (if you can, I don't expect you to know everything) the fact that I am not on a low carb diet (on the contrary) and my total cholesterol is higher than normal for the first time in my life? GP said not to worry, we'll repeat the tests in 3 months and we'll see but I am worried. I don't eat fatty stuff more than once a week, my main fat source is olive oil.

[carorees]

As I said in my post, fasting OR a low carb diet results in becoming fat adapted and hence increased cholesterol. If you are fasting you need to use your fat stores to provide energy during the fast, so you have to have fat circulating in your blood to reach the places it is needed. The fat you eat has little effect on this because when you eat carbs any excess is converted into fat, when you fast this stored fat is called upon to provide energy.

When you get your cholesterol checked again make sure they test for HDL cholesterol. Total cholesterol levels are fairly meaningless as the HDL component is actually beneficial so if you have high HDL levels you can be healthier with a high total cholesterol level than someone with a lower total cholesterol but low HDL cholesterol. If you are worried, give the surgery a ring and find out what your HDL level was, and if they didn't test for it, tell them off!

Since I am still young and have no suck problems, they don't test separately. I do blood tests every 3 months (because of a health problem that needs monitoring) and once a year they check my blood sugar, total cholesterol and other stuff that are included in the yearly check up.
My doctor said that next time we'll check each cholesterol separately and we'll take it from there.

[carorees]

Bet you find your ratio is fine...

That's what the doctor said. She blamed it on the lamb, LOL!

As I said in my post, fasting OR a low carb diet results in becoming fat adapted and hence increased cholesterol.

Might be better to say may result....

http://jcem.endojournals.org/content/89/6/2717.full for example reports the same total cholesterol level in a low carb intervention, with higher HDL and TAG.

Fats from storage used as fuel appear as free fatty acids (FFA) in the main, cholesterol may also be involved or released at the same time but I do know many low carb people report improved total cholesterol levels.

When you have more small, dense LDL particles (called Pattern B), it is much more predictive of coronary-artery disease than when the particles are large and less dense (Pattern A).

Regarding the LDL particle size, when people switch to a low-carb diet, the patterns change in a favourable direction.

Low-carbohydrate diets tend to raise HDL cholesterol levels. Reducing carbohydrate in the diet generally has a positive effect on both HDL and LDL blood cholesterol and triglycerides.

Tomtank, this is good to read.
But, how do we know that an LDL of 6 will be in the healthy ratio of Pattern A being in excess of Pattern B? My diet is well down on carbs now, and triglycerides have risen slightly, but still well in the healthy range, and HDL is rising nicely. Am I correct in assuming the LDL type is the healthy sort? How can I find out?

140lbs and anyone who likes nerdy stuff should looks at the New Varady paper: ADF increases LDL particle size... topic, which I had missed until now.

Dr Varady has shown that alternate-day fasting (ADF) improves LDL cholesterol particle size irrespective of a 'low fat' (6% saturated fat, 13% monounsaturated fat, 6% polyunsaturated fat and 0% trans fat) or a 'high fat' (14% saturated fat, 20% monounsaturated fat, 11% polyunsaturated fat and 0% trans fat) diet. Curiously HDL levels were not changed by ADF.

I can't find anywhere (in UK anyway) that offers a test which can separately measure pattern A ('light-buoyant') and pattern B ('small dense') LDL cholesterol .

I can't find anywhere (in UK anyway) that offers a test which can separately measure pattern A ('light-buoyant') and pattern B ('small dense') LDL cholesterol .

sounds like a challenge

http://www.regeneruslabs.com/portfolio/ ... cle-panel/ any good ?

I can feel a Phd coming on for someone here! Great information coming out in this thread.
Thanks everyone, just as well I am a lady of leisure these days, so I can indulge myself in this sort of education.

Nice catch PhilT!

I think their test is only available to healthcare professionals so it would be a matter of persuading your GP (or similar) to request it. It measures the density and number of lipoprotein particles in the bloodstream. They say that what matters for cardiovascular risk is not the amount of cholesterol but the number of lipoprotein particles in the bloodstream. There is a relationship between LDL cholesterol levels and numbers of lipoprotein particles but not necessarily a simple one.

They also say:

More than 30 percent of the population has cholesterol-depleted LDL, a condition in which a patient’s cholesterol may be “normal” but their lipoprotein particle number, and hence their actual risk, could be much higher than expected. This is especially common in persons whose triglycerides are high or HDL is low. In the population with a cholesterol-depleted LDL, there can be up to a 40 percent error in [conventional] risk assessment.

They also show another interesting if rather more complex chart:

The x-axis (horizontal) is size of lipoprotein particle, from very low density (i.e. large) on the left, through to high density (i.e. small) on the right, and y-axis (vertical) shows the numbers of particles found within each size boundary. You want to be in the green area for all sizes - i.e. low levels of the low-density particles on the left and plenty of high-density particles on the right. The drawn line (with 3 peaks) shows an example profile produced by their test.

Edit: Just to add to that, I think that the downward nudge in the colour profile to the right of the second peak is for the pattern B LDL - to the left of it is pattern A?