Agree. These medications probably have little value. See a cohort study: Global Effect of Modifiable Risk Factors on Cardiovascular Disease and Mortality. The Global Cardiovascular Risk Consortium*published in NEJM 10/2023 about cardiovascular risk factors. Notice the graphics in particular that compare risks of cardiac events and death with relation to BMI, BP, smoking, diabetes, and non-HDL cholesterol. Some signal for stroke and heart attack, but no difference in hazard ratios for death with non-HDL cholesterol risk factor. One might wonder that a stroke could be worse than death if you are debilitated after the stroke, of course. Diabetes is the strongest risk factor in this study, BY FAR. I have heard of the increased risk of diabetes with statin medications and am not sure if this is causation or association. I would sure hate to prescribe a statin if it increases risk for diabetes, as this sounds like a risky move. As a family physician, I lay out this controversy to actively involve the patient in the decision, but I do not strongly recommend lipid lowering medications due to the side effect profile and non-effectiveness in general.
Vlada,
Very detailed explanation of the metabolism of cholesterol and triglycerides. Good Job! When I am trying to explain this to my patients, of course, I have to skip multiple steps of this discussion. I do focus on the insulin piece and inform them that high insulin levels prevent weight loss and causes weight gain. I also stress, as you mentioned, dietary intake of cholesterol and triglycerides, has little effect on these numbers, instead, focus on carbohydrate intake to move the needle. I include in my discussion, that total LDL mass may not be a great measure and talk about large buoyant LDL vs. small dense LDL (seems to be evidence of a difference in risk). I let them know that low-carb, high-fat diet causes a shift from small-dense to large buoyant LDL in most. I discuss how the circulating apo B proteins become altered in a high glucose environment, preventing the liver reuptake receptors from recognizing them, resulting in a longer time in circulation, more opportunity for oxidation, and hence theoretically, more likelihood of atherosclerosis. I also acknowledge that almost all other physicians will try to prescribe a statin or other medication to lower their LDL. I tell them that these will indeed lower the LDL cholesterol. I am very skeptical that these reduce mortality risk, however. We discuss statin side effects, as well. In those patients that fit the phenotype of lean-mass hyper-responders (see Dave Feldman's work) and are also low-carb, high-fat eaters(which I am one), I counsel them about risk. Sometimes, we even get a CAC score for further clarification and tracking. I admit, I took the wrong approach for 20+years in medicine, but I feel that you and I are on the correct path now. This is an uphill battle against the established dogma, stay strong and true!
Very accurate! Research is tainted. I don't debate that statins lower LDL, I think they do. This reduction does not equate to reduced morbidity or mortality though. Even through that lens, if you look at absolute risk reduction (instead of relative risk reduction) in these statin trials, it is dismal-as a population, mind you, possibly gain 30 days of life in the most generous interpretation of the data. My wife saw a diagnosis on a patient chart the other day that had a diagnosis of "intolerance to statin". She is a physical therapist who has joined me in the quest for truth. She joked, "it is like you are SUPPOSED to take these medications, your body does not have enough statins." I think this speaks to how far this medical misinformation has gone. I am not afraid to tell my patients that I feel that triglycerides and VLDL cholesterol are more important and a great marker for insulin triggering and glucose load. I explain the VLDL, triglyceride, sugar connection. I also warn them that other doctors will likely immediately recommend you take a statin if they see you. I tell the patients why, so they are prepared, because it is confusing. For me, bitcoin lead me to Twitter. Twitter lead me to stumble across the low-carb, high-fat community and the rest is history.
Vlada,
Here is a link to my newest post regarding creatine.
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Lowcarbdoctor
I agree, testosterone is vital! I am a physician who treats men and women with bioidentical hormones. Investigate BioTe if you are interested. I am a BioTe provider. I replace hormones with pellet insertions under the skin. This treatment can literally recover lost years of quality of life for my patients!
Insan,
Thank you for this information! I am a physician also interested in immune function. I have enclosed NOSTR links to some of my posts regarding immune function. Enjoy!
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Vlada,
Nice article! I have printed metabolic syndrome pages in my exam rooms. I circle how many of the 5 criteria that they have when I am with a patient in the room. This starts the process of helping the patients think through where they are headed if they don't make a change. I use this opportunity to give them a vision for a different life and healthy choices.
Agree! I rank DM as the highest risk for ASCVD! If we can lower triglycerides and VLDL cholesterol with low-carb diet, then we theoretically decrease the possibility of the VLDL becoming small dense LDL, decrease risk of damage (oxidation) of the LDL particle and likely invading the blood vessel wall in an inflammatory way preventing badness. After I switched to low-carb, high-fat, my total and LDL cholesterol jumped up massively, but my triglycerides and VLDL are quite low. I had a coronary calcium score for my own information and it is zero and I am 53 years old. Suffice it to say, I will not be taking a statin medication. You will find this humorous, my 2nd labwork was performed at a different lab than my first. At the bottom of my lab printout it stated, consider workup for familial hypercholesterolemia.
Vlada,
Some other books to consider if you have not read them in no particular order: Jason Fung: The Diabetes Code, The Obesity Code, The Complete Guide to Fasting; Gary Taubes: Good Calories, Bad Calories (one of my favorites-similar to Teicholz); Ivor Cummins: Eat Rich, Live Long; Tim Noakes: The Real Meal Revolution; Eric Westman: End Your Carb Confusion. The more I read, the more I am convinced that this is the correct prescription for our patients.
Vlada,
I like your content! I am a physician that agrees with you! Here are some of my posts!
Lowcarbdoctor
Diet and low-carbohydrate links
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I am a physician and interested in complementary medicine. See my NOSTR link below:
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Rowe,
I am a family physician who is quite interested in stress. I like your article! Please see my NOSTR links to articles that I have written related to stress and let me know what you think.
Lowcarbdr
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