Do you have information on statins and stroke prevention? My mom had a stroke 2 years ago and it was attributed to her genetically high cholesterol and was put on a statin because she already lived quite a healthy lifestyle. She has cognitively declined since starting the statin.
The best way to know if you have a problem that even requires a statin is to have a calcium score test (Google it). It is not usually covered by health insurance but costs $100-$150 and will tell you if you need a statin (or a bypass, or a stent) without the guessing.
Lots of “plausible mechanisms” here. But not a lot of endpoint data to support your dismissal of the LDL hypothesis.
You’ve also failed to distinguish “primary prevention” vs “secondary prevention” when it comes to statin efficacy (and in particular, efficacy against clinical outcomes rather than mechanistic theories).
You’ve also specifically failed to mention or acknowledge the wealth of outcome data specifically with regards to LDL lowering (and statin use). I acknowledge such data is less compelling with non-statin LDL lowering (such as ezetimibe and PCSK-9 inhibitors).
Finally, you mention “inflammation”, and presumably suggest that it, and/or “metabolic syndrome”, is largely to blame. But you’ve not provided any outcome data to sustain your assertions.
You are correct that “treat to target” is itself not evidence based, since trials measured outcome effects of “LDL lowering” vs not; or of high dose vs low dose treatment. There have been no outcome studies using an “LDL clamp”.
I also agree about the small ARH of (high intensity) statin use and new onset DM. However, that signal is already accounted for in secondary prevention outcome trials.
As for keto diet, I’d be a little more bearish about its overall benefits (https://www.sciencedirect.com/science/article/pii/S0146280624000410). (I recognize this data may have come out AFTER your OP). But as far as outcome data goes, there is much better data for Mediterranean diet (Predimed in primary prevention, and Lyon Heart in secondary prevention) than anything keto enthusiasts can dream of, to date.
Please keep writing on this—I believe patients and the general public are getting the message. I recently had a patient with pretty high cholesterol according to the current guidelines—started on a statin by another provider although her 10-year CV risk is pretty low—under 5%. On the statin her A1c jumped to nearly equal a diabetes diagnosis and nothing else had changed. In UpToDate —there is a section on “significant” adverse effects—and then, relegated to a different section—a 3% incidence of new diabetes diagnosis is reported for the statin. I’m disgusted—seems to me a new diagnosis of diabetes is very significant.
- the first, self evident, is that diabetes is not good for your body and then you need to take another bunch of meds (with a whole set of adverse effects) to manage your blood glucose
- since having diabetes puts you automatically at higher risk of heart disease, cardiologists and diabetologists want your cholesterol to be even lower, so they are going to increase your statin doses
Hey Remnant, I'm a paid subscriber and noticed that I have not been receiving all your stacks. Found this one on notes, cross checked my inbox and did not see this one.
So here is something interesting for you. I come from a long lived family, my grandpa was the youngest who died just before his 90th birthday, but he had developed diabetes Late in life. Everyone else has lived to mid 90s at least. My mom is 88, my dad 90. I’m 55. My dads cholesterol, combined, is under 100. It’s so low that he is supposed to be taking meds to raise it but he can’t tolerate the, so he doesn’t. However, he eats SO MUCH fat, like a 1/4” thick on a roll at dinner. He goes through a tub of butter at least once a week, and that’s only one of his fat sources. He hates ‘bird’ so eats beef and pork almost exclusively. I won’t even go into the amount of butter and sour cream he puts on a potato, you get the picture. My dad is mentally sharp as a tack (he’s awesome).
Then there’s me. I have always exercised multiple times a week, I am careful about my diet but I don’t do keto or anything,just try to get whole foods and complex carbs, lots of fruits and veg, lean meats, etc. I track what 8 eat and focus on getting enough protein and fiber. My weight is great. (Upper 130s at 5’7”). My cholesterol is ‘high’. Specifically, my total runs in the 230s, last check LDL was 146, HDL 79, and triglycerides 42. So my triglyceride to HDL ratio is .53. When I had the cardiac IQ test done, my small particle LDL was around 1900. So definitely ‘too high’. I don’t know my moms specific numbers, but her cholesterol has a
Anyway, my moms cholesterol has always been in the normal range. So my question is... what do you think? Am I just unlucky or is there something I could be doing indifferently? Also, I will never go on a statin. The only prescription I have is estrogen and progesterone because of menopause, but the cholesterol thing has been going on for a few years.
The comparison between your parents and yourself is quite telling.
Namely, that you more or less keep your diet to the typical medical recommendation from most sought after cardiologists, primary care providers: whole food, carbs, fruit, veg, lean meat.
Yet, for some reason, your body seems to be responding with a lipid panel that is higher than "normal."
If this should tell you anything, it is that the mainstream understanding and recommendation is faulty at best.
The important things to consider are: how do you feel? Have you noticed any deficiencies in your body or mind's capacity to do tasks it could before, or overcome an obstacle that was previously not a problem?
If I had your lipid panel, I wouldn't really give it much thought. Triglycerides look great. High cholesterol is not necessarily a bad thing.
If I were to make any suggestion: enjoy more animal fat and protein. Enjoy fruit and veggies that are in season and well sourced (avoiding industrial fertilizer and herbicides). Listen to your body.
Thanks! I am active and healthy. The only real issue is trouble getting good deep sleep, but I’m in menopause, so that could be it. I eat 125-135g of protein a day, almost exclusively from real food (chicken, turkey, seafood, some red meat, Greek yogurt, cottage cheese, etc) not protein supplements) I generally feel like my cholesterol is where my body wants it, but the docs keep trying to tell me otherwise. I just try to ignore it and listen to my body.
Is there a more recent study you would recommend on statins causing diabetes than the 2010 study you pointed out? Excellent article by the way-thank you
I'm sure there are, but finding a study as robust would probably take some digging. At this point, it's so well known that doctors regularly check A1c for patients they put on statins to mitigate risk of diabetes.
It is physiologically illogical to claim that it does not.
Unfortunately, the medical industrial complex has washed this away with the phrase "reversible cognitive impairment" despite the fact that only a fraction of the statin-induced cases of dementia show "some" improvement once they stop taking statins.
I am a retired surgical nurse with open heart experience. Being highly suspicious of the benefit of statins , since my father went into kidney failure after being prescribed statins back in the 80’s, I did my own study with patients in our open heart program. The result was that very few of our patients had high cholesterol or LDL. They were usually smokers or diabetics and some over weight. I am a healthy lean and active, tennis, bike riding female who developed pre diabetes while on Crestor 10 mg. I stopped the Crestor and started taking Krill Oil , which seemed to be bringing down numbers but then I developed Atrial fib so stopped the Krill Oil. I recently read an article on substack that indicated Omega 3’s may be causing new Afib occurrences. My take on this is that better living, better health is not thru chemistry.
"LDL levels can be elevated in individuals with low thyroid activity because T3 helps sensitize the LDL receptor on the cell membrane. Lower active T3 will cause an inability of the LDL particles to dock on the cell membrane drop the cholesterol and fat soluble nutrients into the cell. So the body adapts and increases the amount of overall LDL cholesterol similar to how insulin goes up in response to insulin resistance." -- Dr David Jockers
Dr. Guy Abraham and his group in the early 2000's had a series looking at iodine deficiency in thyroid disease and fibrocystic breast disease. (They used the Japanese breast Ca comparison to US prevalence to make the point.)
Current opinions on iodine deficiency point to other halides as displacing iodine- fluoride from water sources but also from fluorinated cookware coatings, chlorine in water and some source of bromine were all criticised. This would be in agreement with Dr. Johnkers' observation and increased appreciation of the lack of (unexamined) micronutrients in our refined diets. In 40 years I don't recall ever measuring anodyne level for clinical use.
My Medicare Advantage HMO plan mandates two exams per year, which I call the "Are you still alive?" visits. My cholesterol is always a bit north of 200, which causes my doctor great angst. This in spite of the fact that I am probably one of very few "old" patients she has (I am 76) that have no prescriptions, no metabolic diseases, and start each day with 100 push-ups and a 5k walk. Dr. Robert Lustig says that the triglyceride to HDL ratio is a predictor of heart disease, and a value of 1.5 means "you will live forever". I'm at 1.6, and proceeding on the assumption that I have ¼ of my life yet to be lived. I'm a firm believer in Dr. Peter Attia's concept of "Medicine 3.0" in his book 'Outlive', which is based on your root cause approach.
"LDL merely transports cholesterol"...and fat soluble nutrients such as vitamins A, D, E & K to the cells to enable proper functioning and deal with oxidative stress. We will end up with severe disease if not dead without LDL.
Throw them out. I got my mother and my father off of them. They had been on them for many years and you do not need to titrate down. You can just stop them.
Do you have information on statins and stroke prevention? My mom had a stroke 2 years ago and it was attributed to her genetically high cholesterol and was put on a statin because she already lived quite a healthy lifestyle. She has cognitively declined since starting the statin.
The best way to know if you have a problem that even requires a statin is to have a calcium score test (Google it). It is not usually covered by health insurance but costs $100-$150 and will tell you if you need a statin (or a bypass, or a stent) without the guessing.
I don’t think calcium scores are all they are cracked up to be.
How so? Can you explain in more detail?
https://www.remnantmd.com/p/monologues-4-heart-disease-and-cholesterol
Thank you
May have linked the wrong one, check this out if so
https://www.remnantmd.com/p/coronary-artery-disease-calcium-scores?utm_source=publication-search
Lots of “plausible mechanisms” here. But not a lot of endpoint data to support your dismissal of the LDL hypothesis.
You’ve also failed to distinguish “primary prevention” vs “secondary prevention” when it comes to statin efficacy (and in particular, efficacy against clinical outcomes rather than mechanistic theories).
You’ve also specifically failed to mention or acknowledge the wealth of outcome data specifically with regards to LDL lowering (and statin use). I acknowledge such data is less compelling with non-statin LDL lowering (such as ezetimibe and PCSK-9 inhibitors).
Finally, you mention “inflammation”, and presumably suggest that it, and/or “metabolic syndrome”, is largely to blame. But you’ve not provided any outcome data to sustain your assertions.
You are correct that “treat to target” is itself not evidence based, since trials measured outcome effects of “LDL lowering” vs not; or of high dose vs low dose treatment. There have been no outcome studies using an “LDL clamp”.
I also agree about the small ARH of (high intensity) statin use and new onset DM. However, that signal is already accounted for in secondary prevention outcome trials.
As for keto diet, I’d be a little more bearish about its overall benefits (https://www.sciencedirect.com/science/article/pii/S0146280624000410). (I recognize this data may have come out AFTER your OP). But as far as outcome data goes, there is much better data for Mediterranean diet (Predimed in primary prevention, and Lyon Heart in secondary prevention) than anything keto enthusiasts can dream of, to date.
Please keep writing on this—I believe patients and the general public are getting the message. I recently had a patient with pretty high cholesterol according to the current guidelines—started on a statin by another provider although her 10-year CV risk is pretty low—under 5%. On the statin her A1c jumped to nearly equal a diabetes diagnosis and nothing else had changed. In UpToDate —there is a section on “significant” adverse effects—and then, relegated to a different section—a 3% incidence of new diabetes diagnosis is reported for the statin. I’m disgusted—seems to me a new diagnosis of diabetes is very significant.
Yeah, and that's for two reasons:
- the first, self evident, is that diabetes is not good for your body and then you need to take another bunch of meds (with a whole set of adverse effects) to manage your blood glucose
- since having diabetes puts you automatically at higher risk of heart disease, cardiologists and diabetologists want your cholesterol to be even lower, so they are going to increase your statin doses
Hey Remnant, I'm a paid subscriber and noticed that I have not been receiving all your stacks. Found this one on notes, cross checked my inbox and did not see this one.
So here is something interesting for you. I come from a long lived family, my grandpa was the youngest who died just before his 90th birthday, but he had developed diabetes Late in life. Everyone else has lived to mid 90s at least. My mom is 88, my dad 90. I’m 55. My dads cholesterol, combined, is under 100. It’s so low that he is supposed to be taking meds to raise it but he can’t tolerate the, so he doesn’t. However, he eats SO MUCH fat, like a 1/4” thick on a roll at dinner. He goes through a tub of butter at least once a week, and that’s only one of his fat sources. He hates ‘bird’ so eats beef and pork almost exclusively. I won’t even go into the amount of butter and sour cream he puts on a potato, you get the picture. My dad is mentally sharp as a tack (he’s awesome).
Then there’s me. I have always exercised multiple times a week, I am careful about my diet but I don’t do keto or anything,just try to get whole foods and complex carbs, lots of fruits and veg, lean meats, etc. I track what 8 eat and focus on getting enough protein and fiber. My weight is great. (Upper 130s at 5’7”). My cholesterol is ‘high’. Specifically, my total runs in the 230s, last check LDL was 146, HDL 79, and triglycerides 42. So my triglyceride to HDL ratio is .53. When I had the cardiac IQ test done, my small particle LDL was around 1900. So definitely ‘too high’. I don’t know my moms specific numbers, but her cholesterol has a
Whoops, accidentally hit enter too soon.
Anyway, my moms cholesterol has always been in the normal range. So my question is... what do you think? Am I just unlucky or is there something I could be doing indifferently? Also, I will never go on a statin. The only prescription I have is estrogen and progesterone because of menopause, but the cholesterol thing has been going on for a few years.
Hi Valerie,
The comparison between your parents and yourself is quite telling.
Namely, that you more or less keep your diet to the typical medical recommendation from most sought after cardiologists, primary care providers: whole food, carbs, fruit, veg, lean meat.
Yet, for some reason, your body seems to be responding with a lipid panel that is higher than "normal."
If this should tell you anything, it is that the mainstream understanding and recommendation is faulty at best.
The important things to consider are: how do you feel? Have you noticed any deficiencies in your body or mind's capacity to do tasks it could before, or overcome an obstacle that was previously not a problem?
If I had your lipid panel, I wouldn't really give it much thought. Triglycerides look great. High cholesterol is not necessarily a bad thing.
If I were to make any suggestion: enjoy more animal fat and protein. Enjoy fruit and veggies that are in season and well sourced (avoiding industrial fertilizer and herbicides). Listen to your body.
Thanks! I am active and healthy. The only real issue is trouble getting good deep sleep, but I’m in menopause, so that could be it. I eat 125-135g of protein a day, almost exclusively from real food (chicken, turkey, seafood, some red meat, Greek yogurt, cottage cheese, etc) not protein supplements) I generally feel like my cholesterol is where my body wants it, but the docs keep trying to tell me otherwise. I just try to ignore it and listen to my body.
Is there a more recent study you would recommend on statins causing diabetes than the 2010 study you pointed out? Excellent article by the way-thank you
I'm sure there are, but finding a study as robust would probably take some digging. At this point, it's so well known that doctors regularly check A1c for patients they put on statins to mitigate risk of diabetes.
Great points. I’ve seen a lot of issues regarding the need to rethink cholesterol management.
Years ago, One of my Drs made me swear never to take a statin & get my numbers down naturally
Sounds like a keeper.
Is there any correlation between long term statin usage 30+ years
and Alzheimer’s/ degenerative dementia?
I believe there is an easy case to be made.
Statins do cause dementia.
It is physiologically illogical to claim that it does not.
Unfortunately, the medical industrial complex has washed this away with the phrase "reversible cognitive impairment" despite the fact that only a fraction of the statin-induced cases of dementia show "some" improvement once they stop taking statins.
In 1850, heart disease was the 25th cause of death, on par with accidental drowning.
Today a 40 yr old has as much of a chance of dying from a heart attack as a 70 yr old in 1970.
Weren't statins supposed to help?
https://romanshapoval.substack.com/p/why-heart-disease-is-an-electrical
I am a retired surgical nurse with open heart experience. Being highly suspicious of the benefit of statins , since my father went into kidney failure after being prescribed statins back in the 80’s, I did my own study with patients in our open heart program. The result was that very few of our patients had high cholesterol or LDL. They were usually smokers or diabetics and some over weight. I am a healthy lean and active, tennis, bike riding female who developed pre diabetes while on Crestor 10 mg. I stopped the Crestor and started taking Krill Oil , which seemed to be bringing down numbers but then I developed Atrial fib so stopped the Krill Oil. I recently read an article on substack that indicated Omega 3’s may be causing new Afib occurrences. My take on this is that better living, better health is not thru chemistry.
Afib could happen due to age, too? Krill oil not that toxic, but helpful for cardioprotective
reasons.
"LDL levels can be elevated in individuals with low thyroid activity because T3 helps sensitize the LDL receptor on the cell membrane. Lower active T3 will cause an inability of the LDL particles to dock on the cell membrane drop the cholesterol and fat soluble nutrients into the cell. So the body adapts and increases the amount of overall LDL cholesterol similar to how insulin goes up in response to insulin resistance." -- Dr David Jockers
Brilliant, I didn't know this.
Dr. Guy Abraham and his group in the early 2000's had a series looking at iodine deficiency in thyroid disease and fibrocystic breast disease. (They used the Japanese breast Ca comparison to US prevalence to make the point.)
Current opinions on iodine deficiency point to other halides as displacing iodine- fluoride from water sources but also from fluorinated cookware coatings, chlorine in water and some source of bromine were all criticised. This would be in agreement with Dr. Johnkers' observation and increased appreciation of the lack of (unexamined) micronutrients in our refined diets. In 40 years I don't recall ever measuring anodyne level for clinical use.
My Medicare Advantage HMO plan mandates two exams per year, which I call the "Are you still alive?" visits. My cholesterol is always a bit north of 200, which causes my doctor great angst. This in spite of the fact that I am probably one of very few "old" patients she has (I am 76) that have no prescriptions, no metabolic diseases, and start each day with 100 push-ups and a 5k walk. Dr. Robert Lustig says that the triglyceride to HDL ratio is a predictor of heart disease, and a value of 1.5 means "you will live forever". I'm at 1.6, and proceeding on the assumption that I have ¼ of my life yet to be lived. I'm a firm believer in Dr. Peter Attia's concept of "Medicine 3.0" in his book 'Outlive', which is based on your root cause approach.
Used to be a fan of Dr. Attia, til I heard him recommend taking the experimental mnra/bioweapon?
"...But, what about LDL cholesterol..."
Except there is no such thing.
LDL merely transports cholesterol
And cholesterol is cholesterol...
"LDL merely transports cholesterol"...and fat soluble nutrients such as vitamins A, D, E & K to the cells to enable proper functioning and deal with oxidative stress. We will end up with severe disease if not dead without LDL.
excellent points!
Thanks for this.
Want to get my mom off statins who's been on them since a bogus "high cho" result 2 or 3 decades ago (when she was in early thirties!!).
But apparently doctor said that once you've been on them for so long you "shouldn't get off them."
Any value to this concept at all? Or can I encourage her to throw them out
Throw them out. I got my mother and my father off of them. They had been on them for many years and you do not need to titrate down. You can just stop them.