Lipids and Triglycerides

Hoping for some insights from the smart folks here.

My friend (who has a tick bite history) has had increasing lipids and triglycerides over the years, to the point that her doctor now wants her on a statin. She exercises, ingests zero cholesterol, supplements omega 3 fatty acids, and consumes very little processed food (zero trans fats). She's wondering what to make of this and how she might go about managing it. Her cholesterol has been high her whole adult life. Anyone know about managing stubbornly high cholesterol?

She also has floating, oily stools and wonders if this could indicate something relevant. She's on meds for hypothyroidism (and avoids soy), has a slew of food allergies (yeast, almond, peanut, gluten), and is moving into perimenopause.

i was listening to a very smart lady MD who was on Huberman's podcast the other day

he doesn't get everything right - and sometimes seems to mix his own unfounded theories with the science - but i mainly listen for the guests - and thought the lady doctor was very good

she was an MD - but had given up her conventional ear nose and throaty specially - in favour of studying and promoting overall metabolic health as better way to help many more people.

sadly something like 97% of Americans have metabolic dysfunction as defined by having one or more metabolic markers outside the normal range ( a mind bending number).

two of the 5 or so main markers of metabolic health used in studies are raised levels of triglycerides and raised cholesterol ( mainly HDL)
as you can imagine - most of these cases in the society at large are primarily caused by diet and lifestyle choices - which you mention is pretty optimal in your friends case-

but the episode went on to describe models and concepts for what is going on at the cellular level and how that might relate to markers on tests - which could be applicable to all cases

for instance she described tri-glycerides in the blood going up when the cells could not use the energy being supplied by the diet - if for instance the mitochondria were not working well - this would show up as your friend having fatigue or at least sub optimal energy. likely also higher than normal levels of oxidative stress.

the episode was quite rightly mainly focussed on diet and exercise as the main causes of metabolic dysfunction in the population at large - but it may still be worth a listen

https://www.hubermanlab.com/episode/dr-casey-means-transform-your-health-by-improving-metabolism-hormone-blood-sugar-regulation

saraeli said...
My friend ... has had increasing lipids and triglycerides over the years, to the point that her doctor now wants her on a statin. Her cholesterol has been high her whole adult life.

Has she been diagnosed with familial hypercholesterolemia?

saraeli said...
She exercises, ingests zero cholesterol, supplements omega 3 fatty acids, and consumes very little processed food (zero trans fats). She also has floating, oily stools and wonders if this could indicate something relevant. She's on meds for hypothyroidism (and avoids soy), has a slew of food allergies (yeast, almond, peanut, gluten), and is moving into perimenopause.

If she ingests zero cholesterol, then she must follow a vegan diet. Do you know any specifics about her diet? What foods does she eat? Does she eat low fat? High fat? Was she always a vegan? If not, when and why did she change?

How about her liver function tests? Do you know anything about them?

Sorry for all the questions, but the more information the better.

Meanwhile, other than statins, two things come to mind: (1) Nicotinic acid, and (2) Cholestyramine. If those (or, other non-statin interventions) don't make a difference, though she might want to consider the statin to reduce LDL.

Trkane, that's hilarious! I like how they have to specify in the abstract that the results do not constitute health advice, lest we all binge Oreos.

Quin, Garzie, and Blazer, I passed your advice along. Thank you.

Blazer, you say that high LDL is associated with tick-borne infections. It's surprising to me, given how prevalent high LDL is in the general population, that a correlation can be drawn. By what mechanism does tick-borne disease raise cholesterol? Just by causing general metabolic dysregulation? She has had many tick bites but has not been treated for tick-borne infections, so it would be good to know if this might be a reason for her to explore the tick-borne disease angle further.

Dude, she has not been diagnosed with familial hypercholesterolemia. She has followed a vegan diet for 15 years for ethical reasons, and has the aforementioned food allergies and soy avoidance. She eats exclusively homemade, organic, whole foods. Her olive oil comes from a friend's farm directly from Greece right after it's pressed, and a sunflower farm one state over. (Fresh oils, is my point, not the rancid ones bought at the grocery store.) She uses local maple syrup as her only sweetener, and rarely uses that. She buys the rest from local farms. Potatoes, rice, beets, cabbage, kale, ferments, lentils, beans, hummus, carrots, onions, corn, quinoa, avocados, cashews, walnuts, squashes, various other vegetables and fruits, and dark chocolate make up her diet. I don't think she monitors the amount of fat in her diet, but she does supplement omega 3 fatty acids.

Her doctor has never done a CMP or checked liver function. As far as I know, she's only had testing done for vitamin D (low normal), CBC (fine), thyroid (hypo so medicated), and cholesterol.

Some bodies that don't consume cholesterol due to a plant-based diet are genetically predisposed to overproduce cholesterol, but I don't know if that's HDL or LDL. I know some generally vegan folks who supplement eggs once per week to correct this, and she is considering that. People with plant-based diets more often have low cholesterol (which can cause issues if it's too low) so that's what most vegan-literate nutritionists can advise about.

Thanks, all!

Thanks for the detailed answers, Sara.

As for your friend's diet, I'm impressed by her strict adherence to whole foods and sourcing the best ingredients. Some of it may be due to necessity, but I'm guessing she's also very health conscious. If so, the high lipids must be quite frustrating for her.

In hindsight, I realize I should have asked whether your friend was TESTED for familial hypercholesterolemia ("FH"). I had only asked whether she was DIAGNOSED with FH. Your response means either she was tested and was negative...or, she wasn't tested.

If she wasn't tested for FH, I would think that might be a good thing to do. I'd also think that running a CMP (to investigate liver function) would be something to investigate in this scenario, too, if not once per year like most doctors. The results of both tests might better inform the conversation with her doctor about statin therapy. What do you think?

On the other hand, since your friend has had high cholesterol her entire adult life and her lipids and triglycerides keep increasing, that must be enough clinical criteria for her doctor to suggest statin therapy? I just searched for the cholesterol level required for statin therapy. Here's what I found:

Bing A.I. said...
"For adults aged 20 to 75 years, maximally tolerated statin therapy is recommended if their LDL-C (low-density lipoprotein cholesterol) level is 190 mg/dL or greater. Additionally, for patients with a 10-year atherosclerotic cardiovascular disease (ASCVD) risk of 7.5% or higher, moderate-intensity statin therapy should be considered if their LDL-C levels are 70 mg/dL or higher. For individuals with diabetes, the primary goal is to achieve an LDL cholesterol level below 100 mg/dL. Remember that individual patient factors and risk assessments play a crucial role in determining the appropriate treatment approach."

* Do you happen to know her LDL number? Or, total cholesterol minus HDL?
* Does she have Pre-Diabetes or Type 2 Diabetes?
* Was her cholesterol and triglycerides also high on her non-vegan diet?

If she were interested in trying it, she could use Cronometer or something similar for a couple of weeks to track her food intake and look at how much dietary fat she's consuming. If it's more than 15% total fat (as a percentage of calories), she could try an actual low-fat diet for a month or two and get another lipid panel.

Considering all the plant foods she eats, there's a chance she might be eating low-fat. However, with nuts and oil, it doesn't take much of either to end up with a high fat intake. Personally, I would avoid all oils. Olive oil is mostly monounsaturated (around 75%), but still contains around 14% saturated fat and around 10% polyunsaturated fat. It's also a processed food and the most calorically dense food.

Finally as for her hypothyroid situation, I just learned the following:

Bing A.I. said...
"Low Thyroid & High Cholesterol: When you have an underactive thyroid (hypothyroidism), your thyroid gland doesn't produce enough hormones, including T3 (which stimulates the breakdown of cholesterol) and T4 (which increases the number of LDL receptors). As a result, your body can't effectively break down and remove LDL cholesterol (the "bad" cholesterol) from your bloodstream. Studies show that people with high thyroid-stimulating hormone (TSH) levels (indicative of hypothyroidism) tend to have significantly higher total cholesterol and LDL levels than those with normal TSH levels."

"Treating hypothyroidism with thyroid hormone replacement therapy often lowers cholesterol levels in affected individuals. It's essential to address both conditions simultaneously to reduce the risk of heart disease, stroke, and other health complications. Lifestyle changes, such as a heart-healthy diet and regular exercise, can further support cholesterol management in individuals with thyroid disorders."

I'm not sure if any of this will be helpful, but I hope so. Unfortunately, I have more questions than answers. I'd like to hear more about what interventions your friend tries and what happens as a result, if you care to share.

_

Post Edited (The Dude Abides) : 5/12/2024 4:13:37 AM (GMT-8)

most triglycerides in the blood are made by the liver from excess carbohydrates in the diet - rather than coming from fats in the diet directly

so again - i would suggest either the liver is being stimulated to make too much - or the cells are not burning them as fuel as readily as they should be - or both

either way i think your friend has metabolic problems at the root of the issue

if it were me i would want to try to figure out the root cause - rather than take drugs to cover up the symptom
especially as the main drugs used - statins - cause around 50% of people to have undesirable side effects - body aches, fatigue etc - which it sounds like she can do without

btw - the largest study on statins in the world was done in the UK - it found them effective in lowering chances of death in people who have already had stroke or heart attack - but not in primary prevention (reducing the chances of you having a stroke or heart attack in the first place ).

as mentioned - tick born illnesses are one driver for this

hypothyroid conditions tend to push it in that direction also

has she had a full thyroid panel? - ( reason for asking is that most doctors just give synthetic T4 and many patients cannot get optimal free T3 or T4 levels from that ) - see astro's recent TSH thread for optimal ranges

what were her blood sugar markers - fasting glucose, A1C etc?

is she overweight - if so how much?

I did! I have passed along your thoughts, and we shall see what she does with them. I appreciate everyone helping to brainstorm about this.

It's awesome how you follow up, Dude.

I will add that my friend sees only a conventional medicine primary care doctor, so I highly doubt she gets full thyroid testing done, nor many of the tests we here would want in her situation, so unfortunately I don't know the answers to many of your (helpful and wise) questions and probably never will unless she decides to see a different type of practitioner. Perhaps asking her more questions like these will encourage her to look deeper, even though I understand that lots of people find that stressful and would rather just do as the doctor orders, especially since doctors act so confident that their recommendation is the right choice!

Garzie said...
this scientist wrote a paper demonstrating how inaccurate many of the messages we get told about diet are - often they are based on outdated models

"Oreo cookie Treatment Lowers LDL Cholesterol More Than High-Intensity Statin therapy in a Lean Mass Hyper-Responder on a Ketogenic Diet: A Curious Crossover Experiment"

Article said...
in this case study experiment, short-term Oreo supplementation lowered LDL-C more than 6 weeks of high-intensity statin therapy in an LMHR subject on a ketogenic diet. This dramatic metabolic demonstration, consistent with the lipid energy model, should provoke further research and not be seen as health advice.

https://pubmed.ncbi.nlm.nih.gov/38276308/

he showed his cholesterol markers actually improved when he added a bunch of oreo's to his diet
the reasoning is quite interesting

I got super Lyme brain right now Garzie. Help me understand this finding. Is this saying that a person who is on a very low carb diet that is using fat for energy had a dramatic decrease in LDL from adding oreos to their diet? Is this because a person using fat for energy will have lots of lipids in their blood to act as a fuel source for their cells and when a high carb food like oreos was introduced the body was able to switch over to using glucose and the lipids in the blood decreased?

oh aditionally I wanted to say that I feel much better on 1g Phosphatidylcholine. Apparantly its not only good for the outer cell membrane of mitochondria but also helps the liver process fat better, and thus may decrease LDL.

cheers