So...

My cholesterol is consistently over 200 (230 to 275 range) and my LDL over 129---although not by that much. My FBG is always fine, I'm now at normal weight, I exercise, I don't smoke and I don't have family history of early heart disease.

I'm female and 55.

But...those pesky cholesterol numbers always mean that well-meaning nurse practitioners (even at OB-GYN!) say: you'd better watch that. Better check your diet. Oh boy, look at that number, it's in red!

I must say that my cholesterol numbers are very stable over time (last 10 years) and don't seem to change much (except triglycerides) whether or not i'm exercising a lot or whether I'm low-carbing. They are what they are.

Latest shows tot cholesterol=252
HDL = 105
LDL-c = 135 (yes, not necessarily accurate with low tri's)
triglycerides= 62
fasting glucose=74

(all numbers were fasting)

The ratios of total cholesterol:HDL, triglycerides:HDL and LDL:HDL are all great.

However I'm predicting a meeting with the cardiology nutritionist where they query my diet, tell me that more healthy grains will be beneficial and that less saturated fat will get that pesky LDL down.

I did ask them to do the particle size measurements before the 2 hour consult with cardiologist, nurse practitioner and nutritionist, but no dice. I'm grinding my teeth a bit. I think the cardiologist is good enough that he won't suggest statins, but really---I'm not looking forward to this. I don't expect that the low carbing will be well received even though the weight loss has been great.

Any advice from those who've dealt with this?

There really is no proof that high cholesterol causes CVD, its a dying hypothesis!

If it were me??? I wouldnt go back - altho I wouldnt have gone in the first place. The only time I had my cholesterol checked 10 years ago, my doctor told me it was too low and that was bad, as low cholesterol is a marker for cancer!!

Jo xxx

What was it someone here once said, "Arm yourself for hunting bear."

Take a look at the ginormous list of articles I've collected regarding cholesterol and statins and be ready to defend your ground from the charging grizzly (aka doctor).

You may be surprised how much the views of cardiologists are starting to change. In fact, if you look the new AHA guidelines, I don't think you even fall into a LT risk category unless your age triggers it. If you read back a few threads, some cadiologists are choosing not to abide by the new guideliens anyway.

Your numbers are fantastic, as you know! Your total is high because you have a VERY high amount of "good" cholesterol. The new LDL-C cut-off is 190, so you are way below that too, your LDL is not pesky in the least. And you can always quote the study shows that women with TC over 260 live the longest.(one of my favorites for older women) Dr. Davis, Lundell and Miller are all cardiologists who know heart disease is about inflammation, not cholesterol. numbers.

You could tell the nutritionist that you lost weight by restricting sugar and processed foods, eating only real, wholesome foods. If you are eating vegetables, you are not technically restricting carbs. Unless with that long amount of time for your appointment, you want to take on the task of educating her, or go hunting for bear.

This thread has links to the new calculators and a great article from Mayo about how the decision to take statins should be a SHARED one between patient and doctor. Bring a copy to share with doctor.

http://forum.lowcarber.org/showthread.php?t=458356

I'd decline the 2 hour consult about nutrition. I would also decline the office visit with a doctor to discuss the numbers, since I would not have anything to ask the doctor. Unless you have questions other than what we've talked about.

I'm curious why you are seeing a cardiologist….is it only because of your somewhat "high" cholesterol or are there other factors leading to the visit?

ETA: I don't mean to get too personal, and feel free not to answer specifically. I just wondered if this "high cholesterol" is what precipitated the visit.

Thanks everyone!

Liz--no, not too personal.
I'm seeing a cardiologist/lipid specialist because my impression is that I'm in a very low risk category, yet my internist and everyone else just says that any LDL over 129 (my lab's guidelines) or total cholesterol over 200 is elevated and a problem. And I want to put that to rest!

Yes---I agree that's ridiculous! I wanted to see if there was any more nuanced info from the lipid specialist. I've read up on HDL, and it appears that not all of it is necessarily "good". I agree that inflammation is an important part of things. But no one so far has tested my C reactive protein or homocysteine. Hopefully the low-carbing is helpful for that side of things.

When I called the office today to ask about testing for particle size or for inflammation, they said--just come in and we'll take it from there! Arggghh. So I'm going to give it one shot. I haven't taken fish oil lately, since I didn't want it to skew my #s as I thought it might have in the past. But I may want to take that for inflammation/mental health benefits later.

Thanks for being so helpful and sympathetic. I'll report in on how it goes. And I will try not to scream at the nutritionist

Danica, I can relate - my TC & LDL are always high too (and my TG & HDL are good, but not as good as yours - bravo!). I choose to put myself through the process of discussing with experts, though.

My family history of cardiac events is terrible (women too), for instance my dad survived what for 99% of people would have been a sudden-death MI at the age of 50 (he's a doctor and called an ambulance immediately - had he hesitated he'd be dead). He eats low carb now, but also does take a statin & anti-thrombotic.

I go back and forth on whether or not I should take a statin, my goal is not to avoid medication or question whether everyone should be on it, just whether for me personally with my family history it's useful and frankly I'm still unsure. I've taken statins, gone off, taken again - currently off, but continue to monitor the numbers periodically. And I'm scanning for a good lipidologist (not all cardiologists are, by the way) someone who won't hide behind 'guidelines' and will instead look at me as an individual. Of all the doctors I've seen, so far my generalist is still the one I trust the most, and he's fine with my periodic drug holidays, admits that as a pre-menopausal woman there is no evidence of statin benefit, but that my numbers raise eyebrows and family history warrants serious consideration of treatment (one grandmother was dead due to heart disease within 5 years of menopause). For now he & I agree the most important thing for me to do is to continue to work to get my weight down, so for now that's my main focus - but the cholesterol thoughts are never far from my mind (I have 2 very young children).

Anyway, sending you solidarity for your appointment!

Hey ParisMama,

Good points. So important to realize that each of us has a unique family history and set of risk factors and so we have to navigate this whole thing carefully and weigh the risks and benefits. Sounds like you are doing the best for you. And I'm older, but I agree, when you have two young kids doing things to insure you are around and healthy for years to come is a high priority! Congrats on your impressive weight loss.

So...here's the scoop.

It was a mixed bag. The specialist said that my cholesterol was great and that anyone who told me otherwise should be ignored. Given my triglycerides my LDL should be light and fluffy. No need for statins unless my LDL was over 190.

So far so good. Asked how I'd lost the weight and I said LC. He said, oh, and of course low sat fat? I fessed up that I didn't believe sat fat was bad. I've been eating (gasp) red meat. So...that turns out to be where there is just no reasoning or compromise.

They "know" sat fat is bad for you (causes heart disease AND cancer) and even coconut oil is to be avoided. Use healthy oils especially canola (?!)

I think given my numbers are ok (whatever that even means anymore) I have two choices---go with what they tell me, or ignore them. Doesn't seem to be a middle way.

I'm going to choose to ignore them My way seems to be the way of high HDL, low triglycerides and good FBG.

They suggested I up my carbs, "since your body needs carbs". And maybe I could have some ice cream occasionally. And yes, the words "healthy whole grains" were uttered, and I thought of this forum and smiled.

There is no point in discussing things or arguing, since they "know" you are wrong.

I loved this. P)

Thanks for reporting back. It sounds like your doctor is in need of reading chapter 2 of Big Fat Surprise whereby she tells why we *think* saturated fat is bad for the heart. I've just started the chapter so don't know what new revelations she may have, but I know she concludes it is *not* bad (as of course many others have done as well).

I think it is funny that they suggest you eat ice cream - does that not qualify as saturated fat?

Glad to know you are going to stay the course and do what works for your body. Anecdotally speaking, I've always had decent HDL (60s) and good trigs (60s) but since I dropped carbs and increased fat, HDL is now in 90s and trigs in 40s. I can't be the only one.

Wow Liz---that's fantastic on the HDL and trigs! That's inspiring.

I find it amusing that the nutritionist wanted me to modify my diet to "improve' things--and I asked her what she thought needed improving and she said--more complex carbs! The circularity of the argument is unbelievable.

You'd think since I have the good numbers they'd be telling other people to follow my lead

You'd think! But since cardiologists are so busy placing stents, and don't have time to read all the studies, nor books apparently, you could send him this short summary that readers of the WSJ now understand.
http://forum.lowcarber.org/showthread.php?t=459961