I am curious about the studies that look at the detriments of lowering cholesterol too much and also looking at just a basic lipid profile with no further exploration as to size of particles (the larger LDLs being ok) before administering medication.
I do respect your willingness to support hour patient’s choice! too many physicians will not even discuss options.
Excellent write-up. We need those who have very high cholesterol to up the fiber in their diet. And eat fish weekly. In the U.S. some supplements are not pure.
You are correct that the number of lipoproteins (APOB) is the best indicator of risk but it is their cholesterol cargo that causes the problem. Not the actual APOB protein.
Thank you Dr. Barrett. My cholesterol, especially my LDL is too high. So I started taking a Rosuvastatin and have added psyllium and plant sterols along with steel cut oats to my mostly healthy diet (lots of veggies, sustainable or organic meat and eggs), don’t eat fast foods and exercise 5-6 hours a week. Fish oil is no longer helping much but still take it. Stress can increase cholesterol and I feel overwhelmed these days. After reading this, I’m glad that I changed my mind about statins. I’d like to see your thoughts on micro-dosing statins per functional health podcast I listened to.
Looking forward to the article on diet and potential to reduce cholesterol. Cant really find clear advice on this. Reduce saturated fat, yes, but no specific guidance, and lots of stuff about eating almonds etc. Hoping you can give the definitive summary.
Lots of potential to do so with reducing saturated fat and some other approaches but my take is that very few get to the lower bound target needed without some form of pharmacotherapy. Its a reasonable thing to do but I often find is insufficient.
I was surprised that there was no mention here of the value (or not) of reducing one's consumption of saturated fat. For those with high LDL numbers and whose regular diet includes high amounts of saturated fat, is that not a sensible thing to try?
Absolutely a sensible thing to try. The dietary approach to cholesterol is an entirely separate piece and this was more focused on non prescription approaches but yes reducing Sat fat can make a difference.
I'm not convinced that LDL is a cause of CAD or not, but I'm also not convinced that low LDL and taking statins is bad for me. Thus, I take my meds and my lipid numbers are stellar.
I sure tried, with 2 different statins, but quickly felt ill and very foggy. Couldn’t function well at work or even feel safe driving. So, that’s a “no” for me.
It all depends on time frames. If you are 80 years old with no plaque and high LDL then the utility of lowering is obviously less. But if you are younger then it's still a role of the dice. Regardless it does mean that your very near term risk is likely to be low.
I have high LDL but I have no intention of going on statins. From what I understand high LDL only becomes a problem when combined with inflammation so I consume natural anti inflammatory foods and supplements. There’s a logical disconnect between reducing cholesterol and the much higher incidence of Alzheimer’s/dementia since statins started being so widely prescribed. The brain is largely comprised of cholesterol. Reducing cholesterol could be related to this surge in mental illness and I have no confidence this will ever be researched because there’s no money in it for Big Pharma. And frankly COVID convinced me to question the safety of anything doctors and Big Pharma wants me to take. That trust won’t return until and unless they admit the harms they caused and at least apologize for them. I lost my best man and an uncle to those unnecessary harms. So I appreciate your refusal to insist on giving patients something they don’t want.
Good article, and I appreciate that ot doesn't suggest lowering dietary cholesterol. Which seems to number unrelated to serum cholesterol levels. I'd note that adding compounds can be done by adding things to a diet, not just by swallowing capsules. Increasing fiber is hard to do using supplements.
As a person who has arterial issues onwme one side of the family and cognition issues on the other, I'm likely to try to address rising cholesterol without stating, then move to statins if and when those don't work. I don't think that's Luddite or obstructionist, I think it's common sense for many. This is a good list to have. While there may not be studies that show effectiveness in a population, fir any one person it's easy to determine effectiveness with regular testing.
I understand there are some new supplements including lactobacillus plantarum that have shown in studies to decrease cholesterol. One is going under the name of LPLDL. Do you have any information about that?
I find it interesting that statins require a prescription. Is there really opportunity to abuse them or cause irreversible side effects? The main advantage may be that my employer benefits cover perscription drugs but not over the counter ones. Taking the statin hasn't been much inconvenience but I prefer not to see doctors.
Peoples responses are very varied. In general lowering sat fats will lower LDL-C but experimenting with this in the context of a nutrition strategy is a sensible thing to do.
I am curious about the studies that look at the detriments of lowering cholesterol too much and also looking at just a basic lipid profile with no further exploration as to size of particles (the larger LDLs being ok) before administering medication.
I do respect your willingness to support hour patient’s choice! too many physicians will not even discuss options.
Excellent write-up. We need those who have very high cholesterol to up the fiber in their diet. And eat fish weekly. In the U.S. some supplements are not pure.
Thoughts RE: neg coronary artery calcium scan in face of skewed lipid profile?
The answer as always is - it depends. This is something I will be writing about in a future article.
You say "The evidence that high LDL cholesterol CAUSES coronary artery disease is overwhelmingly clear"
I thought the number of lipoproteins was the cause (apob), not their content. Or is it beign too nit-picky ?
You are correct that the number of lipoproteins (APOB) is the best indicator of risk but it is their cholesterol cargo that causes the problem. Not the actual APOB protein.
Thank you Dr. Barrett. My cholesterol, especially my LDL is too high. So I started taking a Rosuvastatin and have added psyllium and plant sterols along with steel cut oats to my mostly healthy diet (lots of veggies, sustainable or organic meat and eggs), don’t eat fast foods and exercise 5-6 hours a week. Fish oil is no longer helping much but still take it. Stress can increase cholesterol and I feel overwhelmed these days. After reading this, I’m glad that I changed my mind about statins. I’d like to see your thoughts on micro-dosing statins per functional health podcast I listened to.
Looking forward to the article on diet and potential to reduce cholesterol. Cant really find clear advice on this. Reduce saturated fat, yes, but no specific guidance, and lots of stuff about eating almonds etc. Hoping you can give the definitive summary.
Lots of potential to do so with reducing saturated fat and some other approaches but my take is that very few get to the lower bound target needed without some form of pharmacotherapy. Its a reasonable thing to do but I often find is insufficient.
I was surprised that there was no mention here of the value (or not) of reducing one's consumption of saturated fat. For those with high LDL numbers and whose regular diet includes high amounts of saturated fat, is that not a sensible thing to try?
Absolutely a sensible thing to try. The dietary approach to cholesterol is an entirely separate piece and this was more focused on non prescription approaches but yes reducing Sat fat can make a difference.
I'm not convinced that LDL is a cause of CAD or not, but I'm also not convinced that low LDL and taking statins is bad for me. Thus, I take my meds and my lipid numbers are stellar.
I sure tried, with 2 different statins, but quickly felt ill and very foggy. Couldn’t function well at work or even feel safe driving. So, that’s a “no” for me.
Thankfully there are more options than statin therapy available.
Curious which two you tried, Kitty. I was foggy on Atorvastatin, but am doing well on Rosuvastatin.
Comforting to hear as I started it about month ago. Potassium test tomorrow morning.
Started with Rosuvastatin, really impactful, and then simvastatin which I cut in half. Still no good.
What if you have high LDL and no evidence of arterial plaques?
It all depends on time frames. If you are 80 years old with no plaque and high LDL then the utility of lowering is obviously less. But if you are younger then it's still a role of the dice. Regardless it does mean that your very near term risk is likely to be low.
Thank you. I’m 61.
And am unable to tolerate statins.
I have high LDL but I have no intention of going on statins. From what I understand high LDL only becomes a problem when combined with inflammation so I consume natural anti inflammatory foods and supplements. There’s a logical disconnect between reducing cholesterol and the much higher incidence of Alzheimer’s/dementia since statins started being so widely prescribed. The brain is largely comprised of cholesterol. Reducing cholesterol could be related to this surge in mental illness and I have no confidence this will ever be researched because there’s no money in it for Big Pharma. And frankly COVID convinced me to question the safety of anything doctors and Big Pharma wants me to take. That trust won’t return until and unless they admit the harms they caused and at least apologize for them. I lost my best man and an uncle to those unnecessary harms. So I appreciate your refusal to insist on giving patients something they don’t want.
Good article, and I appreciate that ot doesn't suggest lowering dietary cholesterol. Which seems to number unrelated to serum cholesterol levels. I'd note that adding compounds can be done by adding things to a diet, not just by swallowing capsules. Increasing fiber is hard to do using supplements.
As a person who has arterial issues onwme one side of the family and cognition issues on the other, I'm likely to try to address rising cholesterol without stating, then move to statins if and when those don't work. I don't think that's Luddite or obstructionist, I think it's common sense for many. This is a good list to have. While there may not be studies that show effectiveness in a population, fir any one person it's easy to determine effectiveness with regular testing.
I understand there are some new supplements including lactobacillus plantarum that have shown in studies to decrease cholesterol. One is going under the name of LPLDL. Do you have any information about that?
I find it interesting that statins require a prescription. Is there really opportunity to abuse them or cause irreversible side effects? The main advantage may be that my employer benefits cover perscription drugs but not over the counter ones. Taking the statin hasn't been much inconvenience but I prefer not to see doctors.
What's your opinion on carbohydrate contribution to high cholesterol versus dairy and animal fats?
Peoples responses are very varied. In general lowering sat fats will lower LDL-C but experimenting with this in the context of a nutrition strategy is a sensible thing to do.
Thank you. Would it be worth getting a lipid genetic profile blood work to identify PCSK9 as it seems one size does not fit all ?
I was expecting Plant Sterols like Benecol to be included in the article. Do you think they work?
My LDL for the first time is raised 2.95 mmol/L, Triglyceride 0.68 mmol/L,
HDL 2.76 mmol/L , Non-HDL 3.26
mmol/L
T.Chol/HDL Ratio 2.18
I have started taking Benecol - I did not know about the other options you mention here.
In your opinion are they a better choice than Benecol?
Thank you .
They have been shown to modestly lower cholesterol. The question for all of us is our lower target and that depends on many factors.
What about Cholesterol-Off?
And the effect of statins and cholesterol levels on all cause mortality?
Surely that is the metric we should be discussing?