FUDiabetes

Reducing risk of CVD in your T1 child


#22

A recent (8 weeks ago?) meta study of very good quality concludes that, while you can get some benefits I think in cardiovascular health, the overall mortality effect is still negative. Possibly somebody has a reference to it?


#23

Thanks for the replies. I’ve been chewing on this for a while. My inclination during these past 5-10 years of LCHF was that cholesterol doesn’t matter, A1C is the ultimate goal. You all have me rethinking my diet…

My cholesterol has been high since my diagnosis at age 28. I don’t know what it was prior, because who goes to the Dr when they’re young and healthy? My numbers typically run about like this:

Total Cholesterol - 200 to 250
LDL - 120 to 150
HDL - 65 to 85
Trig 35 to 50

Looking at the TC and LDL numbers, it looks pretty bad. However, my ratios (TC/HDL, LDL/HDL, Trig/HDL) are all very good. My Dr has suggested various statins over the years, which I politely decline due to the ratios.

Looking at my cholesterol test results going back ten years, I can see that the best results were when I was eating oatmeal (and presumably, not high fat, low carb) HDL 67 LDL 80 (TC and Trigs not recorded at that time). And the worst cholesterol I recorded was when I was working out, increasing weight from 165# to 190#, eating high fat, high protein…I noted I had 7 eggs and bacon for supper the night before the test! TC 313 HDL 85 LDL 212 Trig 81

I have no family history of stroke or heart issues, or diabetes. My mother (72 YO) and Father (73YO) do have high cholesterol, and take statins to cope with it. I presume this constitutes family history of hyperlipidemia.

In view of all of this, I believe I’m going to reduce fats to around 30% overall specifically reduce saturated, and add back in oatmeal, beans, etc, and see what happens to the cholesterol (LDL, specifically).


#24

I know there are many opinions on statins. FYI, as a data point, I have been taking 80 mg of atorvastatin since I turned 50, and both my cholesterol levels and ratios are amazing–my GP tells me he gives my numbers to his other patients as an example of how well it can work. Like you, I have bad factors in my heredity, so I consider myself at risk, despite good nutrition practices in the past 15 years.


#25

Mike, I am sure you are aware of this already, but just to share it with anyone who doesn’t already know, oatmeal and other high fiber foods can reduce LDL.

Another thing that can be used is psyllium, which is available in pill form, so it is even easier than oatmeal.


#26

My LDL has ranged from 2.3 to about 3.1 (in Canadian numbers) over the past years. The target here is <2.0 for people with diabetes. I have been reluctant to go on “unnecessary” medication, but I’m at the point where I just don’t care anymore. I have enough medical crap going on at age 36 that I’m willing to do whatever I have to do to stay healthy and alive long-term. No one is able to tell me for sure what is right or wrong, and so far in my life following doctors’ advice has kept me alive. I don’t have the energy at the moment (literally) to study all this myself, so I’m just going to listen to my doctors.


#27

I didn’t really say it above, but I’m not big on statins, primarily due to high incidence of side effects, some of them very serious. In addition, I sometimes wonder: as complicated as the inflammation and cholesterol puzzle is…is lowering LDL with drug therapy a good idea? What are the unintended consequences of such therapy? We are all familiar with cases of folks we know who are loaded up with medications, each trying to combat the side effects of another medication… The body produces cholesterol in response to inflammation, correct? So maybe a better approach is to try to lower the inflammation, and not just “remove” the body’s protective band-aid without lowering the inflammation?

Thus, I’m intending to explore the diet/exercise route of better blood panels.

Thanks for the input, everyone.


#28

there’s a book called Cholesterol Down that my husband used previously to lower his cholesterol. He is only 37 but has a strong family history of hypercholesterolemia and a few generations now of folks having relatively early heart attacks. One of the biggest takeaways is that you want the type of fiber in oatmeal (and psyllium husk) – that made a huge difference for him, more so than things like cutting out eggs. In other words, it’s not necessarily what you eat with cholesterol that’s always bad, it’s what you’re not eating instead that helps lower the cholesterol.
That’s not to say that you should eat 7 eggs and bacon in one sitting necessarily – definitely saturated fat in the diet has some effect on cholesterol levels. Just if the goal is to lower cholesterol I think it helps to be strategic.


#29

FThe issue for me hasn’t been statins necessarily, but more so whether statins are necessary. The goals for people with diabetes are SO much lower than for most other people. I converted my numbers to American and my LDL has ranged from 89 to 120. That would be normal cholesterol for anyone else. But because I have diabetes, my goal is below 70. According to my endo, that’s impossible for many people to achieve with diet and exercise alone. And he said this goal may be lowered even further.

If I had high cholesterol - which I read is 160 and above - I’d take a statin no question. But with a cholesterol of 89, is that really problematic? Is it really indicating inflammation? And if so, why, when someone without diabetes would be told it’s great? According to my endocrinologist and cardiologist it is problematic because I have long-standing diabetes. But why is this the case?


#30

Here is some info on that particular topic:


#31

@Eric, this information states that people with diabetes are prone to higher cholesterol. But what I am wondering is why is what would otherwise be considered a normal cholesterol level in someone without diabetes considered high in someone with (long-standing) diabetes? Is it because of the other subtle effects diabetes has?

I’m on a lot of medications for someone my age (more than a dozen, and I’m in my 30s), but each one is to treat specific symptoms of a primary condition. Except for metformin, which I just take because I think it’s beneficial even if I don’t see any particular benefit (although lately I do think I’m seeing a significant benefit). And perhaps Crestor, if you’re suspicious of the lower diabetes targets for cholesterol.

So far, all of the specialists I’ve seen prescribe the minimum dose of medication (unless my symptoms are particularly severe) and work up from there. If symptoms seem better, many of my specialists will suggest reduring the dose. The few times I’ve had medication side effects, the medication has been changed as soon as I let my doctor know (the idea of just going, “Oh, well,” and prescribing another medication to cure the side effect seems outrageous to me). All my medications get reviewed at least yearly, typically by both the specialist who prescribed it and my GP. I’ve decided that doctors have kept me alive and healthy this far, and all of mine seem very up-to-date on research and I believe have my best health in mind when suggesting a medication or treatment.

This may be very different to the US where I think compensation is somehow tied in to prescribing medications…?


#32

There are two parts to it.

Yes, diabetics are prone to have higher cholesterol, that is the first part. But the second part is that cholesterol can have more of an impact on diabetics.

I can’t read through all of the items in the list carefully at the moment, but I think if you go through the list, numbers 1-3 address why diabetics have higher cholesterol, and numbers 4-7 address the issue of why the cholesterol has a bigger effect on diabetics.

Those would be the two different components of the issue.

So if a non-diabetic had an LDL of 90, the doc might say it’s fine. But if a diabetic had an LDL of 90, he might say that items 4-7 mean the 90 is worse for the diabetic than the non-diabetic.

Is that what you are asking?


#33

@Jen, that would not be correct :slight_smile:


#34

Yes, this is exactly what I was asking. Thanks! I’ll go back and look in more detail at items 4-7 this weekend.

My LDL cholesterol over the past ten years has ranged from about 90 to 120 in US numbers, which is “normal” for someone without diabetes. But my endocrinologist and now a cardiologist are both recommending a statin (which I just took first dose of last night).


#35

I keep hearing about how the US system somehow ties compensation to procedures, so thought maybe the same might be true of medications. :slight_smile: But if that’s not the case, that’s really good!


#36

The procedures part is true: a surgeon, for instance, will get paid for visits and for procedures. But a physician who does not do procedures will just get paid for the visit, whatever she prescribes.

Like in other countries, there is some pressure by the patient to get prescribed “something” for what ails them. That is the same everywhere though :slight_smile:


#37

Jen,

I’m thinking this occurs more commonly with elderly, where body systems are not in the best shape, and many medications are used. A case which comes to mind involves my wife’s grandfather, who was living alone, 2 hours away from his daughter, a nurse (my mother in law). He was in his late 80’s, nearly on his death bed. My mother in law looked into the medications he was taking (a bunch of them) and wondered if the side effects from them were causing unnecessary problems. She moved him to a care facility near to her home, and near a trusted physician. They pared down the prescriptions greatly, down to a few essentials. His health improved, and he lived another 10 years or better in good health. My wife could fill in more details on this if needed.

Looking at the Google, I found a couple stories talking about this phenomenon: Consumer Reports and Worst Pills, Best Pills


#38

Yes, I could see how that could happen. I’m glad your wife’s grandfather got things sorted out!

I think that’s a different topic than whether statin use outweighs potential side effects for younger people with diabetes. I think with age it can be hard to tell what’s a side effect and what’s just the aging process. In younger people, hopefully doctors never just prescribe a second medication to take care of a side-effect of a first, unless the first was life-saving and couldn’t be discontinued.


#39

What you point out is why everyone, once they reach a certain age (depends on person) really needs someone in the family to be their medical advocate. Even though my mother is capable of doing it all on her own, we both find it helpful to review her decisions and ask for clarifications from time to time.


#40

Jen and Chris, Yes, medical care for elderly is a different topic. However, younger diabetics like me can use coaching/advocating from significant others and sources like this forum, If I haven’t said it before, I say it now: thanks!

Back to statins: If something can be reasonably accomplished without medications, I would prefer to avoid drug therapy. Not always possible, though.


#41

This is true, and I brought up this same point with my endocrinologist. According to him, many people will never be able to get an LDL cholesterol below 70 (our target converted to US numbers) without medication, regardless of their diet and exercise habits. And he was saying that based on current research findings, that target may be lowered even more in Canada (to equivilent of below 60 in US numbers).

For years I resisted statins because I didn’t want to take them when my cholesterol “wasn’t really high” for someone without diabetes, even though I did have diabetes. Especially when I was in my 20s, I hated the idea of any medication, really. As I’ve learned more about how high cardiovascular risk is for people with diabetes, and as I’ve added more unrelated medications to my regimen, I’ve changed my mind. A lot of my not wanting to take statins was based on fear of side effects. But when being prescribed a new medication I’m always warned about the most common side effects and reminded to let the prescribing doctor know if they happen so they can change to a different medication. And, even though they are hyped online, side effects are in general more rare than common (people don’t generally post to online forums if all is well). So all of that has led me to accept that their long-term benefits likely outweigh any short-term, reversible risks.