Dr. Davis:

Wondering if you could clarify your thoughts a bit. You promote elimination of wheat and corn starch (which I fully believe in) but then also comment on the elimination of carbohydrate (in the aggregate) as being a key factor for health. I'm not convinced that all carb is problematic for a person with a normal metabolism. Of course, it doesn't hurt anything; just wondering at your experience with those who don't go low carb but do drop the wheat.

Thanks.

Scott

So why have so many doctors bought into this whole statin thing?  If you question the need for a statin, you are first bullied to take them and second shown the door if you continue to resist!

Dear Dr. Davis, the improvement you describe for Mr. Lew is mainly because of wheat elimination, fish oil supplements or 25-hydroxy vitamin D increased levels? Or is just because of the significant weight loss and hypocaloric diet? In other words, from your experience, would you expect similar results in other people, for example, with the same approach but with no weight loss at all?

Dr. Davis,

Are you still recommending Niacin?  I haven't seen it mentioned for low HDL in a while.

It would be interesting to know how long Lew's dietary/supplemental changes were in effect before his hsCRP impressively dropped from 4.1 mg/dl to .4 mg/dl?

Two months into a LC diet and two weeks without grains my hsCRP was 2.43 mg/dl, HDL-75, TGs-82, calculated LDL-105, VLDL-16. Yes, my doctor advised me to go on a statin and a low-fat, high fiber diet to lower my LDL number to <75 (not going to happen). In my case, I do not need to lose weight, just manage blood sugar.

Still, it would be interesting to know when to expect a lowering of CRP and what other factors beside coronary plaque determine the measured hsCRP when one is mimicking Lew's strategy?

I have had a dramatic improvement in my hs-CRP, but it occurred slowly. Nine years ago my hs-CRP was over 13 and I was having one stent after another and ultimately bypass. As I made lifestyle changes, my hs-CRP started to fall a little. In 2003 I stopped eating gluten(wheat, barley and rye) and by 2005 my hs-CRP dropped to 4.98.

Now I have given up all grains because of blood sugar issues and my hs-CRP is 2.19 - not perfect but heading in the right direction. My vitamin D is now 54ng/ml instead of 24. I do take fish oil.

I doubt a statin could lower hs-CRP from 13 to 2.19

i have been looking to join the track your plaque website,but the site that asks for a credit card does not appear to be secure/encrypted; it is not an https site for example.  Therefore any data you put in for a credit card is out there in cyber space.  any suggestions?

Great results, Anne!

In general, CRP reductions occur over several months. The phenomenon that both exerts profound effects but can slow the process down is WEIGHT LOSS.

Scott--It depends on whether there are metabolic measures that reflect intolerance to wheat and other carbohydrates, such as small LDL or increased CRP.

Dr. Davis,

when you say eliminate wheat and other food that cause small LDL : which other foods are you referring to? Is it all simple carbs such as sugars, processed foods etc. or something else?

Thanks.

Vin--

Eliminating wheat means just that: anything made with wheat. Otherwise, the effect does not kick in.

The ml/dl units for CRP levels are likely a typo, one that is widely found in the medical literature and confusing for the novice attempting to determine normal serum CRP levels.  Levels above 2 or 3 mg/L are often cited as indicative of increased cardiac risk and levels at or above 2 mg/L (0.2 mg/dl) were required for eligibility in the Jupiter study.

Dr Davis,

I've been on a Low carb diet for the last six months.  My triglycerides is 60, HDL 61 but my direct LDL is 174, APOPROTEIN B is 119. My CRP was .6.  Should I be worried about the APOPROTEIN B score of 119?  My doctor recommended that I take a Statin drug....with the high LDL score and APO_B score.  I don't eat any grains and currently taking fish oil, niacin and vitamin D gel based pills.  I would like to stay away from statins....but I'm getting frustrated in not being able to lower my LDLs through diet.

To those of you who have eliminated grains; reduced your fear of naturally saturated fat (be wary of trans fats and most vegetable oils, though); have seen your HDL go up; etc., but are still worried about what seems like an elevated LDL (remember, it's probably just a calculated number, not a direct measurement), then consider that few primary care docs even see people who eat like that, so  they don't know what to do with the unusual profile that comes up.  They rec a statin as a knee-jerk reaction to any "elevated" LDL number, despite all the other "risk factors" that look fine - it's to cover their you know whats (one doc even said that to me).

I ran into this with my endo who noted in my file the high calculated LDL and total cholesterol numbers (but the ratios and triglyc are great and far better than they were 5 ya before I got my BG under control by restricting carbs, then eliminating wheat).  

In response to the suggestion I consider a statin, despite no other reason besides the high "calculated" (estimated) LDL number, I said, "then let's take a closer look at that LDL.  Please order a detailed cholesterol lipoprotein panel [same as TYP recommends] to directly count and measure the LDL particles, because I think it's highly likely the LDL will be few in number plus will be the large fluffy kind not associated with CVD."  At that point I did know that my atypical high fat, low carb diet that I followed to manage my BG tended to promote the right LDL and minimize the small dense LDL particle formation.  So I wasn't worried at all about the LDL number, but probably most people are conditioned to worry about LDL these days.

That was before I knew about heart scans.  Now that I've had a heart scan with an unsurprising 0 score.  So if I get another statin recommendation (prob less likely now),  I'll say that "there is no measurable plaque in my coronary arteries,  so no thanks" (not to mention the questionable benefit of statins for women, anyway).  

These days, before I consider taking *any* treatment that wasn't needed on an emergency basis, I look into it thoroughly
from ALL angles and make sure no stone is unturned - to be sure I truly will benefit from it and not be harmed (and that means a direct look at the so-called risk factors and side effects or undesireable outcomes, not just an estimate or calculation.  We've been programmed to fear any high LDL number, but we need LDL; that's why we make it -  it serves a physiological function.  We just have to get past the oversimplification of "good and bad" cholesterol and make sure we make the the healthier forms.

Good going Anna!

The cluefulness factor varies a lot between doctors. One of mine noted "weird" lipids without relating them to what was obvious "diabetic dyslipidemia". Many in the UK will only look at TChol.

My current one is more competent than many, she agrees that my slightly high LDL is not dangerous since my trigs and HDL have become so good. But she is adamant that I cannot have CRP or homocysteine tested and lipoprotein panel is totally unavailable. Not entirely her fault, it's those accountants.

I'm trying to educate her into the benefits of carb lowering. She's coming round to understanding my point of view but is restricted by protocols from recommending it to others. I'm getting through better with the nurses who seem more able to suggest useful techniques without fear of being disciplined or losing their jobs.

Hello Dr. Davis,

I'm on a ketogenic diet and in the process of weight loss. Went to the doc and got my blood test to find out that my cholesterol numbers were good, however, I had high CRP (5.5). The doctor immediately suggested statins. No additional tests to rule out an infection or other strategies to determine the cause of the inflammation.

I'm aware that during weight loss the blood test results can be skewed. (You talk about this here: http://www.trackyourplaque.com/blog/2011/09/what-is-this-wacky-thing-called-weight-loss.html) However, given that my cholesterol results are good, I'm wondering why the CRP would be high.

You can get a more detailed background about my case here (which includes blood test results): http://www.reddit.com/r/keto/comments/o4lk8/bloodwork_after_3_months_of_keto/

Sincerely,

A.E.

I know enough to not stress about lipid levels that send some docs for their prescription pads.  However, I was a bit shocked to see my recent numbers as follows:
TC 465
HDL 102.18
Trig 48.95
LDL 353.73
Even doing a more accurate calculation, the LDl is high, although all the ratios seem to be in order.  I'm mid 50's, slim and with no family history of heart disease.  I also do not have any of the indicators for Lp (a).  Anything else that would cause this?

Dr. Davis,

I was wondering why my HDL went up with my latest Lipid Panel test results I received yesterday from my Endocrinologist (Type 2 diabetes). It was a pleasant present on my 60th birthday – HDL of 65!

My Lipid Panel results: - Total Cholesterol -127,     HDL – 65,  Triglycerides – 51,  LDL - 52

I have been taking 4,000 IU of D3 for the past six months after reading your blog. Actually, my HDL was in the mid fifties to sixty since for a few years I have been taking 500 mg of Slo-Niacin along with two Omega 3 fish oil capsules per day. Added to this is four days per week at the gym for the last three years. This helps too.

My HDL has never been so high at 65 and I didn’t realize the positive affect of the Vitamin D3 until the current test results.

I believe my LDL is so low because I am taking a 20 mg dosage of Simvastatin, although I am now taking it every other day. Along with the Simvastatin, I am taking Metformin and Diovan all prescribed by my Endocrinologist. After researching on the Internet I added the Omega 3, Niacin, and from your blog Vitamin D3. My doctor doesn’t have much to say about this, although I have mentioned it to him.

Vitamin D3 really seems to work on the HDL!

Now I really have to try to cut down on my wheat consumption to drop my A1c below 6.4.

I appreciate your blog along with your book.

Thanks for all your helpful information.

David

Anon--

You must--MUST--consider getting an NMR lipoprotein test to obtain the LDL particle number.

Given the very high HDL , it is possible that the true LDL is far, far lower than the calculated LDL. It likely will be high, but not that high.

Great work, David!

Dr. Davis:  How do you know the increased HDL is due to the D3 and not from the wheat elimination you recommend?

Raises TC?!!!  Wow, thanks!  Gonna print out and show to Primary, Endo, and Cardio who are talking statins (Primary said statins or niacin). Comments?

Aug 08: D=15.2, TC=212, TRI=181, HDL=47, LDL=129, TSH=2.795(normal free T3 & T4), A1C=11...50K IU/wk of D2 for 8 wks, then 1K D3 daily. Very low carb diet, metformin ER, Januvia (terrible CNS side effects), Maxzide, Cozaar. BP=140s/65 <1800 mg sodium told to add a bit more.

Dec 08: D=33, TC=205, TRI=119, HDL=57, LDL=124, TSH=4.289 (normal free T3 & T4), A1C=6.9, TSH=2.667(normal free T3 & T4)...2K D3 daily.  Very low carb diet, metformin ER, Maxzide, Cozaar (half dose). BP=130s/75

Jun 09: D=36, TC=231, TRI=119, HDL=57, LDL=150, TSH=4.548(normal free T3 & T4), A1C=6.4...4K D3 daily.  Very low carb diet, metformin ER, Maxzide, Cozaar (1/4 dose) on days following apnea events that wake me up (on CPAP), aver BP=128/72

Sep 09: D=41, TC=235, TRI=145, HDL=60, LDL=147, TSH=5.51 normal free T3 & T4), A1C=6.5 (tried new foods-meals & spiked)...4K D3 daily (thinking of upping to 5-6K).  Very low carb diet, metformin ER, Maxzide, Cozaar (1/4 dose) on days following apnea events that wake me up, aver BP=130/70, started generic Levothyroxine 25 mcg/day, just started Iodoral 12.5 mg a wk ago--body temp finally staying the 98s. Subbing a high-protein (lots of BCAAs) shake for breakfast and 1/2 shake for snack -- lost 4 pounds in 6 days (monitoring BGs frequently). ApoB=111 (<109 normal)...oops.

So, are my rising cholesterol numbers the results of the following or ?
- Very low carb (<40 gms) diet (guessing larger LDL particles)
- Rising TSH levels(hypothyroidism increases cholesterol right?)
- Increased amts of D3

60 yo female. Lost 50+ pounds but still obese (takes time). 35-60 mins/day low intensity recumbent exercise bike. Laidoff--lots of angst & stress.  All other bloodwork results good (high RBC down to normal, guessing less apnea desats). Using topical progesterone, 3 wks on, 1 wk off a la Dr John Lee. No CVD in family, just Type 2 and hypothyroidism.  If niacin is good, which form?  Not sure I can handle flushing, have touchy skin, used to have rosacea.

Anonymous,

Hypothyroidism will jack up cholesterol and LDL.  People can be hypothyroid even if they're slim.  Have you had your FT3 checked?

I actually found different. I've been on 10,000IU of D3 and found a general dip in my cholesterol levels (although a slight increase in HDL).

Here's a scan of my results in '07 (when I was just 15nmol/L) and recently where I'm above 76nmol/L (I just say above as my most recent D reading is yet to arrive).
http://bit.ly/3h9X4C

Of course it may be co-incidence too, but both my brother and father have had no change at all in their cholesterol levels in the last few years. My brother's on D but only just enough as recommended by a doctor.

My levels this year are now well below UK average (which is 5.7mmol/L and I'm now 4.95 from 5.62) and correspondingly I wasn't told to modify my diet or go on a statin, even though my cholesterol level was deemed as only marginally high before.

wow.. how could it be? in fact, if that's gonna be true, not all vitamins are good for the body in the sense that it has a side effect inside the body.

I read this and then immediately ordered some vitamin D.

Anonymous,

Has your LDLs always been this high or have you never had your cholesterol tested before? If so, then perhaps you have Familial Hypercholesterolemia like I do. If your LDLs have been tested before and were never that high, then it must be something else.

Since your Trig. are so low and your TC is over 250, the standard Friedewald equation isn't the most accurate for you. Here is a better calculator for people like you:

http://homepages.slingshot.co.nz/~geoff36/LDL_mg.htm

Regardless, that still is a high LDL. Have you recently started taking new supplements?

The reason I ask is because I was once was advised to take a several difference supplements in the hopes of raising my Testosterone and they all had some zinc in them and my LDLs skyrocketed (even for me)! I later learned that too much zinc can do this. I was taking around 100 or 110mg of zinc daily if my memory serves me correctly. I believe taking too much zinc can adversely affect copper levels which in turn can raise cholesterol. Now I try to stay around 100% to 200% of the RDA (15mg - 30mg) and I don't have that problem.

Are you taking sterols? Maybe you're absorbing the sterols...just a thought.

Maybe it was a just lab fluke. I would recommend a retest (preferably using a NMR or a VAP test).

Good luck!

John M.

Put your numbers through this

http://homepages.slingshot.co.nz/~geoff36/LDL_mg.htm

it brings your LDL down to 286, still a bit high, I'd suggest there's something else occurring, could be thyroid?

One "authoritative" site for calculating cardiovascular risk won't even permit HDL levels over 100 to be entered, so you've aced that, and the trigs

http://www.elements4health.com/cholesterol-buildup-in-diabetes-patients-deficient-in-vitamin-d.html

interesting...have you read or posted on this yet?

LDL Calculator gives
LDL = 353.03  (mg/dL) as per Friedewald formula

LDL = 285.63  (mg/dL) as per "Iranian" formula

Dr Stephan on  Friedewald

Previous Dr Davis post on  Friedewald equation
Triglycerides divided by five

Total Cholesterol is by far a wrong way to measure the risk of heart disease. In this case, if the doctor she was going to was one among many she would have been prescribed statin drugs without further investigation. Higher Cholesterol must be bad right - let's make a buck and sell her some lipitor or Simvastatin! People in general are too uneducated and trust doctors more than anything else. This makes me scared! A low carb high fat (LCHF) diet will gett people more healthy all over! Better cholesterol quota, less over weight, less risk of developing type 2 diabetes, less risk of inflammation, and better energy! You can't go wrong! Thanks for this very important post!

Dr. Davis,
Thanks so much for your response.  Would it make a difference to know that I have eaten low carb for several years, and seldom eat grains?  Also, apparently my lipids were 'normal' when last checked 10 years ago.
My GP claims ignorance of the difference between calculated and direct measure of LDL, or of different particle size.  He just knows the numbers the lab sends.  I believe I would need to see a specialist to get tested further.  Worth the trouble?

Hi, Steve--

You are absolutely correct: Given sufficient time, wheat elimination increases HDL also. However, vitamin D can also increase it independently. I've seen many people add vit D to an already established no-wheat diet and still send HDL through the roof.

Lyn--

As you can see, it's probably a combination of all the good things you've done.

I've been supplementing with 6,000 mg of D3 each day for a month and following a low carb but not wheat-free diet for 2 months. I was surprised to see my HDL come back so low and my LDL so high on a recent test:

HDL: 34
LDL: 203
VLDL: 9
Trig: 47

I will add Niacin to my supplement regimen to help bring down the LDL, and eliminate wheat. I am about 40 lbs overweight, with no other health issues (that I know of!). My A1C and fasting insulin numbers are good (A1C 4.7, Ins 4.3). I wonder if I need to pursue a more agressive approach to bring down my LDL, or just give the Vitamin D/Niacin supplementation time to work (and give up wheat)?

Very good information. Many people do not understand how to decipher the information when they get the results of a cholesterol test. This should help out some.

I started taking 500mg niacin daily
(for 40 days now) and increased my HDL to 49 from 35
but my TC went from 189 to 251!
(my trig is 62)
Can niacin increase TC also?

Lieta--

When it comes to vitamin D and wheat elimination, it generally requires about 6 months for full effect to be reflected in your blood work.

So patience pays!

Anon--

Niacin or any other agent that increases HDL will likewise increase total cholesterol. It's all good!

Do you have a recommended brand of Vit D3?  Does it have to be taken with Vit A (as I've read in some other places)?

Thanks

Does the lack of useful information in total cholesterol value extend all the way down to 150 and below, which is the level Joel Fuhrman and others say people should strive for?

This reminds me of a story that the renowned physicist Richard Feynman told about the poor quality of textbooks he had reviewed, which gave students totally useless problems with no practical purpose.

His example was a problem that listed the temperature of 3 random stars, and asked the student to calculate the total temperature, a totally meaningless and pointless number that tells you absolutely nothing about anything.

I have looked at many sites on this subject and not come across a site such as yours which tells everyone everything that they need to know. I have bookmarked your site. Can anyone else suggest any other related topics that I can look for to find out further information?

Dr. Davis,

Do you have any studies to support that vitamin d increases HDL? I've searched it and could find nothing but neutral studies on it or studies in combination with omega's and niacin.

This study that was ONLY with vitamin d saw no effect.

http://www.ncbi.nlm.nih.gov/pubmed/19352377?dopt=Abstract

and this study showed that atorvastatin needed adequate vitamin d levels in order to work.

http://www.hindawi.com/journals/ije/2010/320721.html

but I couldn't find anything saying that vitamin d raised HDL. Any references that you can refer me to or is this just your observations?

Vitamin D doesn't raise cholesterol - cholesterol uses sunlight to synthesize or create Vitamin D.  If you are taking a cholesterol lowering medication, your body can't process the cholesterol to make Vitamin D.

In May 2008 I had a D3 level of 25. Now it's near 80, after 1+ years on 5000 IU of D3 per day. My LDL cholesterol has gone up (it's in the 170s) and my HDL is still low (40-50). HDL has actually changed very little while LDL has increased over time since the first time it was tested in 2002.

Despite the info presented here, I'm not convinced that there's such a clear relationship between LDL and Vitamin D.

So the dominant effect of vitamin D from a cholesterol standpoint is a substantial increase in HDL. Looking at the equation, you can see that an increase in HDL is accompanied by a commensurate increase in total cholesterol. If HDL goes up 25 mg/dl, total cholesterol goes up 25 mg/dl.

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Thanks a lot for the tips. Reduce your cholesterol by taking the necessary vitamins and supplements. Avoid eating fatty food and focus more on eating healthy fats.

-Supplements Canada

Vitamin D3 supplements will absolutely increase both your LDL and HDL cholesterol.  The impact on each can be quite large.  I know people want to believe that supplements can do nothing negative, but it is what it is.  All you have to do is buy a Cardiocheck PA meter or the like and test your cholesterol at home.  Take 5000 IU per day of vitamin D3 for 2 weeks and recheck -- your LDL will go up dramatically, and your HDL will rise as well (and so your total will increase a fair amount).  The exact same thing will happen if you get massive amounts of sun without sunscreen over a number of weeks.  Who know whether this effect is a good or bad thing -- your guess is as good as mine.  But I'm always amazed at all the $30 million dollar studies that have to be done to find out what any person can see with a single affordable at-home monitor...