High LDL has low risk of coronary calcium
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- เผยแพร่เมื่อ 5 ต.ค. 2024
- A new a study shows that those with LDL above 190 and calcium scores of zero have a low risk for developing calcium or having a cardiac event 10 years later. While this study had nothing to do with low carb eating or hyper-responders, it does make us question the belief that all LDL above 190 is dangerous and needs aggressive treatment. Certainly we can do more and do better at risk stratifying people rather than treating everyone the same.
Read more about the study here
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There is absolutely no correlation between LDL and CAC score. Average LDL for someone presenting in the ER with a heart attack: 104.
On the other hand, study showed quartile with highest insulin levels had 6.7 times greater risk than lowest quartile.
-- It appears that insulin is a big factor as we age.
Try explaining that information to someone with heat disease. My brothet wont even discuss it. "Bad" ldl is ingrained in patients and mainstream doctors.
sorry peter so what should i be worried about how do i improve my chances of no getting a heart attack ?
@@kalinative69 Eat no more than 30 grams of carbs per day.
LDL of 104 IS high LDL. It can be the case that boht high LDL and high insulin are bad. It's not a one or the other. Both indicate nutrient excess.
This aligns with my understanding of LDL.
LDL is required for atherosclerotisis, but not causal.
The root causes of atherosclerosis are glycation or oxidation of the LDL, whick makes is smaller and more dense.
If you keep your glycation and oxidation risks low, then high LDL is harmless.
If you don't, then LDL can cause harm. The question is then, should you lower your LDL, or fix the causal issues?
Since LDL is required for life, hormones, fatty acid and fat soluble vitamin transport, etc., and studies show higher LDL associated with longevity.. it's pretty clear as to the best option.
So how does one reduce oxidation?
Eat less polyunsaturated fat, which oxidize easily, and are transported via LDL.
Glycation?
reduce blood sugar levels
There are other causes of oxidation and glycation in each, but these apply to everyone, are are the primary contributors
I like your screen name. Keep smiling.
👍🏼👍🏼👍🏼
Please, what kind of food is included in polyunsaturated fat ? Thank you 🙏🏻
Are you doctor ? I am thinking to ask you more about heart disease and cholesterol.
Thank you for understanding, and I am waiting for your answer
@@gabriel65304 No, not a medical doctor, but I do work in the medical field.
Part of my job is medical research, but not in these fields.
Studying chronic disease and nutrition has been my primary hobby for the past 5 years or so now.
Initially I started studying Alzheimer's, due to a family history. Digging down to root causes. This lead to the ReCODE protocol and then nutrition, where I started to discover how wrong nutrition advice for diabetes, and other chronic diseases, had been.
Initially thinking lower carb diets were the answer. Low carb diets get clear results, as Alzheimer'slooks to be at least partially a metabolic disease. Type 2 diabetes is clearly metabolic, and can be cured, or rather put into remission in a few weeks to a month.
I started applying these to my life, getting amazing result's, but as I continued to dig, I came across a paradox. There are some high carbohydrate cultures virtually no chronic diseases.
Anytime you have a paradox, odds are, your hypothesis is wrong.
I then heard lectures from *Chris Knobbe,* and started digging more into vegetable and seed oils, specifically Linoleic Acid, and how there is convincing data this is the root cause of most chronic disease, due to their easy oxidation. (This is where atherosclerosis fits in)
Combining this with data from *Thomas Seyfried,* and reading *Tucker Goodrich's* blog Yelling Stop, where he links to many studies supporting it, it also seems cancer is a metabolic disease, caused by mitochondrial malfunction, and structural damage being the major culprit. The primary root cause? Linoleic acid.
This is just a summary of the educational journey I've been on. Many parallel paths and circuitous routes along the way. I'd not consider myself an expert, but am glad to help if I can.
My LDL is 305. CAC scan is zero. Ketovore for 3 years, age 62, never felt better. I walk 4-6 miles per day.
A - ok 👌
You are fake id
my LDL - 205 CALCIUM CORONARY - ZERO - 68YR FEMALE 5'4" 125LB -CURRENTLY CARNIVORE DIET 3yrs - previously KETO 5 Paleo 23
My ldl is 201 and my CAC is ZERO. I’m 5’ 6” and 135
@@RoxanneJ but you can have soft plaque
My LDL went up to 225 and has stayed there on 3 years carnivore. Had a baseline CAC. My score was 5. Good for age 63. Three years later I had another CAC. It was .31. Eating zero carb helped cleaned out my arteries. :0) various GPS wanted to give me statins, but the one I have now believes there’s individual variability.
very nice!
👍🏻
Thank you for sharing that your CAC went down. That gives me hope. After being on Keto for 18 months and losing 50 lbs., my LDL went up. In hopes of countering my doc's insistence that I needed to be on medication, I had a CAC scan. My score was 286. I was actually depressed after learning that, but I have persevered and in another 18 months I lost another 20 lbs. But my LDL is still very high. I would like to have another CAC scan if there is the possibility that my score has gone down. I am 69 years old.
@@bhampatty1 check out Ivor Cummins channel. In-depth discussions about LDL and CACs. Fat Emperor podcast
Having that 286 score stabilized for next years scan is they key
I LOVE these comments!! I found out I had an LDL particle count issue. Went to lipidologist to confirm/ test genetics and otherwise. Wanted me on Lipitor/metformin. After going carnivore and fasting my trigs dropped from almost 500 to 106 in 12 weeks. Insulin 26 to a 5, LDL is 185, cholesterol 280, glucose is flawless and I shed 24lbs. Are these docs nuts? LDL-P and LDL-C are not an issue your glucose is!
Can I ask what is your fasting glucose and A1C?
@@bostonjackson9384 4.8 A1C and 86 ng/dL Glucose
@@christophernieves1215 Those are excellent numbers. Have you had a hs-crp lab taken?
@@bostonjackson9384 not in a while but it’s usually very low
@@christophernieves1215 I've come to the conclusion that cholesterol means little to nothing.... keeping inflammation in check is the key. That's why I asked about hs-crp.
My cal score was a 4 and I’m 54 years old. I was obese until 2 years ago when I started keto(25 grams of carbs per day), lost 85 pounds, I don’t smoke, workout and eat natural foods so I’m hoping it doesn’t go up. My LDL has been elevated for several years but keto has my HDL way up and triglycerides way down. Im feeling great.
I think your next calcium test will show a low score 👌
Don't forget vitamin K-2
@@jamescalifornia2964 without vitamin D 3?
@@jamescalifornia2964 I was told by my cardiologist that it a relatively low considering all the years of unhealthy living I put myself through. Though a zero is what you want he doesn’t get concerned at all until it reaches 100. He said it shouldn’t go up at all as long as I stay the way I am now. Thanks
@@saltrock9642 I recommend you cnsume vitamin k2 and vitamin D3.... and keep us up-to date and future lab results.
my doctor isn't happy with my 187 ldl, yet hdl of 76 and tri of 54 are fine. I probably will be looking for a new doctor. I think he was happier when I was preT2 but cholesterol was 230
@N5S Matter ...only problem with “non compliance” is if you’re being evaluated for life insurance policies or health insurance provided by employers. That being the case, it might be beneficial to accept the prescription and toss it in the trash.
I’m 36 and my ldl is 162, HDL 71, triglycerides 64. My doctor says he’s giving me until I’m 40 to worry about it and put me on Lipitor. Boy is he in for a rude awakening. I am NOT worried about these numbers at all.
You can tell your doctor to get a coronary artery calcium test done.
@@Rocky7729 That’s my plan if he insists when I’m 40. Thank you 😊
@Bladerunner2043 That is old epidemiological science. Look where that has brought us…
@Bladerunner2043 🤔 where’s your proof?
@Bladerunner2043 Great. Please site the studies to prove your claim.
Always a pleasure listening to your presentations Dr. Sher.
The practice nurse berated me for refusing statins because of my cholesterol and for being carnivore etc but my doctor's not concerned. He knew LDL would go up, noted triglycerides in low range, lost 12 kg, and exercising and being active. Happy in body and mind to be off some meds. The nurse did scare me though when she said that 'Well, you're still allowed to refuse medication". Allowed??? I wonder how many other patients she's done this to. She got an earful from me about human rights lol.
...only problem with “non compliance” is if you’re being evaluated for life insurance policies or health insurance provided by employers. That being the case, it might be beneficial to accept the prescription and toss it in the trash.
It’s the ratios that are important, not the single numbers of HDL and LDL. Read the book “Eat Rich Live Long” by Ivor Cummings and Dr. Gerber. They also have lectures on TH-cam. Very insightful.
My LDL went up, but that's because it's carrying fat when I fast because I'm fat adapted-pretty simple. My CAC is a 2 (a remnant from diabetes, no doubt) so no big deal. Had to fire my doctor, though.
Yup. Exactly. It’s your body/genetics doing what it should do.
When you fasting ldl goes up ⬆️ much more, say mostly of people.
my cholesterol levels after 2 months of keto diet, august 2021
HDL- 50
LDL - 275
Try. - 85
Man 53 old, I got a stent in February 2021 , I have stopped all medication after 1 week.
@@gabriel65304 / I take _SloNiacin_ for improved blood fats 👌
@@jamescalifornia2964 I started to take also nutritional yeast flakes, what do you think 🤔?
@@gabriel65304 - / I take brewer's yeast as a natural source of vitamin B-complex - however it likely does not do much for LDL. AMLA powder _( Indian goose berry )_ seems to help.
See this video about niacin :
th-cam.com/video/9pvRzoRSpHI/w-d-xo.html
Been having (or trying to have) this conversation with my doctors for years. They all say "you need to go on a statin". I have no interest in taking a statin at this time.
Since going to a low carb, animal based diet over 3.5 years ago, my overall cholesterol and LD have gone up (LDL 203), BUT, my HDL, Triglycerides, and HDL/Triglyceride ratio all improved greatly! I did get a CAC last year and scored a 14. I plan on asking for another CAC next year to see if it has improved or worsened since I had nothing to compare last years test to.
In addition to the cholesterol changes, my A1C has improved dramatically (no longer a T2D), have lost a ton of weight, no more neuropathy, no more brain fog, and have reversed many other health symptoms/issues.
I went from my failing health to thriving. Just my experience.
It's almost as if coronary artery calcium has _nothing to do_ with LDL. 🤔
How do I talk to my doctor about this, and convince him to do the right tests? What do I ask?
Then at age 68, after 5 months on keto my ldl went up over 200 but my TRG/HDL ratio was 0.72 and my dr. was completely happy with that even though my CAC test just as I was starting keto was 474 which I anticipated since my CT scan the month before showed severe coronary calcifications. Six months earlier a scan showed moderate coronary calicifications. My dr. suggested statins but since I was just starting keto I wanted to try a lifestyle change first. My CT scan a couple of days ago said nothing at all about coronary calcifications.
Also, after a year on keto my severe fatty liver is gone and that recent CT scan just said "upper abdomen unremarkable". "Unremarkable" never sounded so good.
Please, I can’t understand, how many CT scan you got?... and in how many years?
Thank you 🙏🏻
@@gabriel65304 3 in 2020: Jan., July, and a CAC test in August. And I just had a CT scan in July of 2021. The Jan. 2020 scan was scheduled as was the one 6 months later, then the CAC test was done because the coronary calcification had advanced from moderate to severe.
But my scan last month in July of 2021, after a year on keto, mentioned nothing about any coronary calcification.
@@stevec3872 but when you got the artery coronary seriously calcification, you was on keto diet?… or later you started?
For how long time you have the stent?
I have one for 5 months, and after 10 days I refused statins and aspirin.
For 2 months I follow Keto Diet, vitamin D3, k2, vitamin C Acerola .
Exercises. At the moment I I am fine , I can’t say too much because I’m just 5 months after stent.
I am just 53 old.
@@gabriel65304 First, I have no stent. I had the CAC test done to confirm the CT scan finding from July 2020 which it did. It was because of this I started keto in August 2020. My CT scan in July 2021 said nothing about any coronary calcification & my doctor is delighted.
“My opinion only” - I believe we need to separate LDL/numbers from heart issues. Who said it: ?? LDL is blamed by proximity. 🤔🤔
I am a hyper-responder, but not really worried about it. Definitely not going on cholesterol medicine. If my doc gives me a hard time about it at next visit I'll suggest a CAC.
Thanks doc your videos are always helpful and informative. ❤️🤗❤️
My LDL is 539 as a carnivore and zero calcium score so maybe I’ll live forever lol
mine is over 400 doing carnivore too...crazy high, but I am feeling my best!
@@angiesrecipes My CAC was 474 August of 2020, the month I started keto. My last CT scan last month didn't say a word about any coronary calcification while the previous 2 scans noted it was moderate then severe. I wonder what happened?
@@stevec3872 how often did you do the scan?
On February 2021 I got a stent on my artery.
Today I got my blood test cholesterol.
Total cholesterol 8,8
LDL 7,1
HDL 1 ,29
Triglycerides 0,97
Is dangerous?
Thanks 🙏🏻
So here is my N=1.
I have a non zero CAC score (very much non zero, severe...)
The funny thing that for more than 10 years prior to that I was on Atorvostatin (which eventually I "had to" suppliment with HCTZ, then Amlodipine, then Lisinopril, then Metaprolol) . All that glorious time my LDL was around 70. At the end I had full blown type 2 diabetes.
My PCP convinced me to start taking statins because I had fatty liver and my LDL was around 170. She told me "take statins they will protect your liver". And yes my diet sucked at that time, that is it was standard, full of "heathy grains", but I was physically very active, I practice martial arts.
The really humorous part of this is that after getting CAC results my cardiologist prescribes me following:
- another statin (this time Crestor)
- Amlodipine
- Metaprolol (twice the previous dose this time)
Do you think your non-zero CAC score may be caused by hypertension? Because all the medication you were prescribed aside from the statins are for high blood pressure.
@@mouffetteintrepide8445 Hard to say. I think insulin resistance that turned into T2D was the main reason. In my opinion. My BP was "under control" most of the time. The highest what I saw was about 140/90.
I have to say compared to keto all those BP meds are total crap.
Statins won’t make you happy, it’s better low carb as intermittent fasting.. and walking every morning and evening,these 3 things are recommended for all kinds of disease.
But not too much from animals, more fish, and bones broth, and many vegetables
Thanks for sharing the Study.
I wonder how long before we are told that non clogged arteries have nothing to do with Heart Disease and that LDL does ?😂
Hey Thank you Dr. Great helpful video. Q- How does all of this relate to "LDL-P" scores. Thank you
Very interesting. I appreciate the LCHR related material as I am one of them,
Love this channel!
I just got back a LPa lab test with a 129 high result and because its a genetic disposition its of big concern. My total cholesterol went up 375 after 6 months on low carb.
Before I went keto to combat type 2 diabetes about thirty years before I had doctors wanting to lower my cholesterol and nothing else. I tried the horrible powder I had to mix up and drink with a meal and started to become ill with muscle pains headaches and a desire to rip everything apart and stomp on it, so I stopped the medication and didn't touch it again for anther ten years but this time it was a statin which I was able to tolerate with fewer intense side effects but still some unpleasant ones and reduced general health and mood and other mental issues. So I gave up on it again but followed the advice of a healthy low fat etc etc diet. I looked into cholesterol and discovered that the reasoning behind reducing it was based on assumptions and assertions of people who had some very vested interests and very little actual tested science and of the small amount of science involved it was either epidemiological or so badly biased it was ridiculous to think anyone would trust it. But I stayed on the healthy diet even though my weight went up and eventually became T2D until I found Keto and I don't care what my cholesterol score is but apparently is't better than when I was on the healthy diet.
Too bad the study didn't also track TG and HDL, so we could see if that one in 117 wouldn't been even lower risk with correspondingly lower TG and higher HDL.
I am so confused. What if you had a calcium score of over 600 and ldl before keto of 211. I am on medication to keep it under 50. What about those of us with high CAC scores. It is nice for you to say it is a different story!!! What is the story for us?
Keto/IF by August 12 th is 4 years and my PCP & cardio doc are a royal pain about my LDL. I told them unless they investigate the advanced cholesterol- which the ONLY problem is glycated apolipoprotiens which usually is a result of fructose in the diet. So I told them that topic is off the table.
Can you get them to order you a CAC so you can shut them up?
(Also would be good: LipoProfile, LP(a), hsCRP, GGT, fasting insulin, homocysteine, cystatin c. They may not know what to do with all the data, but YOU will 😁)
@@philipkim580 I tried that my cardio said I don’t need it. What he should have said - but there seems to be a bit of hubris going on...maybe because I’m an “old uneducated woman” in his lofty eyes... he could have said there would be shadows on the test that could obfuscate any results BECAUSE I have 19 cardiac stents. I really don’t see him anymore except for my Medicare annual if I need to do that. Why should I invest my $20 copay? I’m on keto/IF 4 years AGAINST his advice so maybe there’s some bad tude too. I don’t have a need to defend myself, I just walk away and don’t give it oxygen anymore.
But thank you for your kindness!
I'm a hyper responder if I eat zero carb, and I'm APOE4/4. CAC = 0. CIMT showed some areas of soft plaque. Although my ratios are fantastic, and NMR confirms my pattern A LDL, my OxLDL is high because APOE4s don't clear LDL efficiently, and I'm having to lower my total cholesterol in hopes of lowering OxLDL. To do it, I'm taking zetia and reducing my sat fat intake (keeping the ribeyes, ditching the butter and heavy cream.)
Age when you had the CAC?
@@MN-wg8qd 60
@@alex_stanley Awesome to hear!
I'm a thin 5' 7" 135 lbs fit 76 year old with no symptoms of any health problems and have been on Keto for almost 4 years. Just got a requested by me CAC scan with a result of 1114.5. My most recent blood test results were a trigyceride/HDL of 1, CRP
With a family history of high blood pressure and heart disease, it's important to work with your doctor to find a treatment plan you're both comfortable with.
@@dietdoctor my doctor who has been on low carb/Atkins for 20 years advises me to continue my current diet and lifestyle regimen with no further tests at this time other than blood testing.
@@roncav8 that’s shocking advice. You may want to get a coronary angiogram and see just how blocked each artery is.
Decades ago LDL was 250.
Then it was lowered to 200.
That means doctors can now consider more people to be considered ‘in danger’ of coronary issues and more people prescribed statins.
Hmmmm.... $$$$$$$$
Is LDL measured directly or calculated with equation? If calculated, every decrease in Triglycerides will increase LDL 😃
I never heard this... do you have specific info or a website you could share? My doc is about to have a heart attack over my high ldl even though my Triglycerides were only 65. Any info you have on direct ldl measurement versus calculated ldl measurement would be appreciated. Thank you.
remember dynamic steady state?
It's so confusing and frustrating to me, how is a lay person make the right desicion if the experts dont agree. My Calcium score was 56 two yrs ago my doctor wants me to take statins due to total cholesterol
Trigs 87, Hdl 96, Ldl 248 vldl 13 Total 357
I wonder Am I a ticking bomb 😔
What do you recommend for someone who has a CAC in the 700’s
My mother who is 87 has a CAC of over 2000 and her cardiologist said she could live to 95.
Please work closely with your doctor for appropriate treatment.
@@dietdoctor What else can you legally say?
What kind of CVD event do you get when your CAC score remains 0?
Usually cardiac arrest from "really old age" syndrome, as you die peacefully in your sleep.
@@Unsensitive That is not exactly true. CAC shows only calcium. It shows first of all a history of inflammation and certain indication of flow obstruction. But it does not show so called soft plaque which indicates ongoing inflammation. And this is the plaque that kills or, at least, causes CV event.
Calcified plaque is usually considered to be stable.
@@tiredlookingforname this was obviously a joke; But yes, calcium is there to stabilize the soft plaques.
Could you possibly have soft plaques without calcification? sure.. but either your body is stealing the calcium from the calcified plaques, such may be possible with high doses of Vit K2; Or you've yet to calcify the soft plaques, at which point they are new.. and your load is probably negligible.
This is not my expertise though, so if you're aware of another mechanism, please let me know. Always looking for the best, most accurate information.
Or was I minunderstanding "your CAC score remains zero"?
I assume they mean it is zero, not that it hadn't increased from the prior tested value.
I am 74 with a total cholesterol of 274. Naturally the doctor wants to put me on Zetia and I am afraid to even try. I have previously been on a very low carb diet but that caused chronic constipation so switched to high fiber diet. I tried low carb for a week and even taking 800 mg of magnesium had problems. I am on 2 blood pressure meds which maybe a partial cause. My question: what is a solution for constipation for the low carb or keto diet?
Here is our guide to constipation.
www.dietdoctor.com/low-carb/side-effects/constipation
Eat avocados
I had similar problems when on a low carb diet. I eventually found the solution to constipation via a you tube video from the mayo clinic (part 4 video of a series on constipation - name of the nutritionist is Michelle). I'm still on low carb with no constipation issues whatsoever.
Strick keto got my tri/hdl ratio from 3.61 to 1.19 ! however my Small LDL is still VERY high! 1148 Should I be worried? Maybe do small dose Rosuvastatin????
Please make sure to work with your doctor for specific medicine questions as they have the larger picture of your overall health history. If you need assistance finding a low carb friendly physician, we have a directory on our website.
www.dietdoctor.com/low-carb/doctors/
@@dietdoctor Thank you!
@@dietdoctor Sadly there is no one near me. My doctor has a myopic view of CV health. My insurance in not that great so I am rather limited. I did all of my ratios last night and they are all in the good category. with the tri/hdl in the ideal category. so for now I guess I just ignore the crp.
In defense of doctors, they are trying to find something that can be relatively easily tested that will let them know if you’re likely to develop heart disease. Everyone got on board with LDL. After 40+ years they’re realizing that other markers (ApoB) may be better.
Wish this was true. I don't think but a tiny fraction of doctors understand that lipid panels are only step one in determining CV health. Most are: lipid panel leads directly to statins prescription.
@@Merzui-kg8ds That’s because doctors have been led to believe patients won’t comply.
I got a CAC about 3 years ago. It was 210. How bad is that? Is it safe to get another score soon?
My biggest pet peeve with this is that you keep using the word "may". Don't talk about studies (a scientific thing seeking as much surety as is reasonably possible) and then use the word "may" (not scientific at all). It's the equivalent of me asking a question and you shrugging your shoulders and saying "maybe". Also, studies on sick people really don't seem to mean much in healthy people.
I'm not sold on extreme diets like the keto diet. Use the keto diet only if you have epilepsy. There is no need for something that extreme for ordinary people.
If you put Keto in the context of the human diet over the last 100,000 years, it is probably not an extreme diet. On the other hand, 300 plus grams of carbs in day is the extreme diet. I see keto as the long term norm, and low fat, high carb as the extreme diet/fad diet
Just a few hundred years ago, people did not have consistent access to the magnitude of carbs that we now can get from any gas station
Except it's not extreme at all. It goes back to before industrial "food" became the standard.