Cholesterol concerns

[CommanderFun]

So, I had my first true physical with the new doctor today, including going over a series of blood tests from roughly a week ago. He blew off the second sub-300 testosterone reading from these tests, but the thing he wouldn't stop getting on me about was cholesterol. Don't have the numbers with me (they were supposed to give me a copy but didn't, now I'm waiting on the lab to process my request for them online), but he was really on me about statins. Fat fucking chance of that. Medicine with those kinds of side effects to treat heart issues when my heart rate and blood pressure are great seems like a terrible idea. So if I'm gonna do something to address the cholesterol levels, it's gonna have to be diet. Here's the thing though, my current diet isn't really high in fat. There are only two meals I eat a day typically that even contain any fat. The only consistent one is my morning eggs. I have 4, and it amounts to about 28g fat with 8 of it saturated. Other than that, there's dinner, which is the only meal I have that varies from day to day. I think the fattiest meal I've had for dinner in months though was three burger king cheeseburgers (60g fat/27g saturated, according to internet). Mind you, this is the only fast food I've had all year and far from the norm. Typical dinner meals for me are typically chicken (cutlets or rotisserie), a pair of soft tacos (homemade, not taco bell), a big bowl of spaghetti (paired with a 16 ounce glass of milk to add some extra protein), or a thin steak.

Because I don't get to pick and measure out my dinners all that well, it seems my options to address this are as follows:
1. Reduce or ditch the morning eggs. I can make up the protein, though I worry about missing a lot of the benefits of eating eggs.
2. Add more fiber into the diet. I should probably do this anyway, but it may especially help with the cholesterol numbers.
3. Up my fish oil dosage? I get 1500mg EPA and DHA right now, but I've seen recommendation of higher doses for greater benefits.
4. Ignore this completely as my cardiovascular health seems fine or even great otherwise (low blood pressure and resting heart rate numbers).

Do you have any thoughts on these options? Also, I have found some limited (and unsourced) information claiming the process of shedding body fat stores can cause increases in blood cholesterol, since the fat content is being evacuated into the bloodstream. Do you have any knowledge of this? I have been deficit dieting since January (down between 1 and 2 pounds a week), and was wondering if that can be throwing the numbers off significantly.

[Robert Santana]

I'd need to see the numbers to form a complete opinion. Did you lose weight rapidly? Were you fasted? Increasing Fish Oil to 3 mg/day could help lower triglycerides if those are high. Again, without knowing the breakdown of the numbers, it is hard telling.

[CommanderFun]

I did lose weight rapidly way back in January, but that was because I overdieted to start things off. Lately it's been about 1-2 pounds per week like one would expect. Which numbers are you referring to, the labs or more detailed diet numbers?

[jfsully]

Statins for primary prevention (preventing your FIRST heart attack) are still controversial, although the association of LDL with heart disease is not as controversial as it might seem in certain corners of the internet. One key to understanding this is the difference between absolute and relative risk. It is possible that reducing your risk by half (significant relative risk reduction) might not really change your actual (absolute) risk of heart attack or stroke appreciably. I usually use the lottery analogy. If you buy 2 lottery tickets, you have doubled your chances of winning the lottery. If you buy 10 tickets, you have 10x the chance of winning. Do you have a good chance of winning? No. But, every lottery, somebody does win. And if you "win" that lottery and have a heart attack, you will wonder if you could have avoided it with the statin. Is that enough of an incentive? Only for you to decide.

If you have ridiculously high cholesterol due to genetics (our liver makes most of our cholesterol, it's not from food), you might really need the statin. If it's borderline, and you can lower it a bit with diet, you probably do not need it.

You might want to look at one of the statin/cholesterol decision calculators to help you decide. This one is decent:

Statin Choice Decision Aid - Statin

There are also other possible benefits of statins: cancer survival may be higher in people taking statins, and dementia rates may be lower. These are speculative, but if you worry a lot about either of those, taking a statin may give you the feeling you're doing something about them. Again, whether this is worth it depends on your preferences. (CF, I think your preference to avoid the statin is clear, but I am leaving this here for others).

[Mainstream]

I'd need to see the numbers to form a complete opinion. Did you lose weight rapidly? Were you fasted? Increasing Fish Oil to 3 mg/day could help lower triglycerides if those are high. Again, without knowing the breakdown of the numbers, it is hard telling.

Are they borderline? High, very high? Whats the breakdown of good to bad? Whats your triglycerides? Whats your A1c ?

Yes docs push statins because they know cardiovascular disease is the #1 killer in US, but I am not convinced that cholesterol is the culprit of atherosclerosis....not convinced at all...

He wont treat a testosterone under 300!? The problem you have now is you have high cholesterol , even docs that treat low T may not teat if cholesterol is too high...maybe make a deal...youll take the statin if he treats your low T
.

[CommanderFun]

My numbers (for the lipid panel) were as follows:
Total Cholesterol 248 mg/dL (<200 was the desired number)
Triglycerides 77 mg/dL (<150 desired)
CHOL/HDLC Ratio 6.5 (<5 desired, I think this is just a derived stat though, but included it for completeness)
HDL Cholesterol 38 mg/dL (>=40 desired)
LDL Cholesterol 192 mg/dL (Didn't phrase it as "desired", but said >190 was bad)
Non HDL Cholesterol 210 mg/dL (<130 desired)

Other than that, the metabolic panel was fine, other than trace urine ketones, which I suspect is because I've been dropping weight. There was also a TSH level over the suggested range, but only by a tiny amount. Previous test from a month or two back had me normal. Scheduled to take a more detailed thyroid test before the next visit in 3 months, but I doubt it'll turn up anything. I have no hypothyroidism symptoms I can think of. Only the testosterone test seemed low, although it WAS within the lab's tolerance range, and from what I've been able to gather through comparison 51.8 pg/mL free is on the higher end, especially with a lower total. That's an entirely different topic though.

(CF, I think your preference to avoid the statin is clear, but I am leaving this here for others).

That is indeed my preference, but I gave it a look anyway since it couldn't hurt to be more informed. The calculator wouldn't even run with my age (35), so I plugged in 40 instead and filled out the rest of my numbers. Standard dose statins had no impact on heart attack risk. High dose lowered it from 2 in 100 people having a heart attack to 1 in 100. A lot of the side effects listed said they were increased in likelihood by high intensity/dosage. So I think I'll go with a hard pass. Thanks though, it was good to be able to have some analysis behind the decision and actually weigh potential benefit vs side effects.

For now, I'm dropping my 4 egg daily breakfast and replacing it with protein-powdered oatmeal. Actually get more protein this way, and more fiber(and carbs in general), which I'm admittedly pretty low on as is. Might go ahead and have the eggs one or two days of the week, like on sunday, which is currently my big eating day for re-feeding.

[Robert Santana]

The LDL is definitely a high value so let's rule some things out.

1) Was this test conducted fasted?

2) Do you have prior data to compare this to?

3) Was this measured LDL or calculated LDL?

I recommend getting your oxidized LDL tested next time as well.

[CommanderFun]

1) Yes.
2) No, no recent prior cholesterol tests. I had bloodwork done 5-10 years back but don't have those results.
3) The fine print for the test says it was calculated using the "Martin-Hopkins" calculation.

[Robert Santana]

I'd get it retested and request a measured and oxidized LDL.

[jfsully]

I'd get it retested and request a measured and oxidized LDL.

In the setting of normal triglycerides, direct and calculated LDL are likely to be quite close, or at least in the same ballpark so as to not change your conclusions about what to do.

I’m curious about the oxidized LDL, though, haven’t seen that tested. I know that oxidized is presumed to be the more pathological subtype of LDL. Is there any evidence that measuring it in addition to or in lieu of “vanilla” LDL adds to the risk determination? I would think it likely that oxidized LDL is generally a fairly fixed percentage of total LDL, and you could spare the expense of the fancy test. Do you have any references on this?