Confused 🤷‍♀️

[TheJazzSinger]

I’m nudging 70 and in November decided to lose some weight. I have about 5lbs to go and have lost 1st. I recently had a blood test which has shown my LDL (4.11) and HDL (2.39) have risen as has my BP. I follow a fasting ( 5days until 1pm and 2days until 7pm) and low carb (not keto 100-150g) diet of loads of veggies, lean protein, no meat 3 days a week, low sugar fruits, no bread, occasional wholewheat pasta and whole grain rice and fish. I walk for an hour nearly every day. Flummoxed as to why markers would increase as everything you read says fasting and low carb decreased everything. Interestingly my HBA1c was 38 and is still 38.

[TheAwfulToad Ambassador]

A few observations:

HbA1c at 38mmol/mol is normal. Or normal enough to be uninformative.

You appear to be eating something like a low-fat Mediterranean diet, not LCHF, and you're calorie-restricted (I'm guessing around 1200-1300kCal a day - perhaps one-third each from fat, carbs and protein).

There's nothing terribly wrong with what you're eating - it's a lot healthier than most people! - but I suggesting adding some fat. The aim of LCHF is really just to get your appetite working so that you're not thinking about macros and calories all the time. To do that, you need to give it adequate calories from fat; you'll then be able to cut your carbs to a more sensible level.

As for your cholesterol, I really wouldn't take much notice. At 70 you can expect your total cholesterol (TC) to be slightly higher than younger people; it's normal. If your TC were falling, then it's time to worry - that usually spells impending doom!

HDL at 2.39 is better than the general population (higher is better). Do you have a triglycerides and TC measurement? And your previous numbers? The usual marker for CVD risk is the HDL:TG ratio, but take all of this with a very large pinch of salt. There is no reliable predictor of heart disease based on cholesterol measurements. It's just a big moneymaking charade.

[TheJazzSinger in reply to TheAwfulToad]

Thank you The AwfulToad. TC 6.7. In 2018 & 2019 my triglycerides were 0.9 (he didn’t test for them this time) and my TC was 5.4 with an HDL of 2.18 and LDL of 2.81 and ratio of 2.5 so pretty normal. I’m just surprised with a healthy diet and 1st weight loss the markers have increased in 2 years. According to my Fitbit food logger, my daily carb intake is anything from 65-115. I’m fasting until 7.00p.m two days a week and until lunchtime 7 days a week. I know when I have a conversation with the doc he’ll push me towards statins which I will refuse. Even with so-called normal markers they push you to take them!

[TheAwfulToad Ambassador in reply to TheJazzSinger]

Your TC will go up slightly because your body is mobilising fat reserves. It'll probably drop (slightly) as your weight loss slows down, but it's unlikely to drop into the doctor's "ideal" range for the simple reason that "ideal" has been defined in such a way that half the population can be prescribed statins.

You can estimate your TG from TC and HDL (because cholesterol is part of the lipoprotein shell that carries triglycerides). In this case it's about 0.44mmol/L, which is much lower than you'd see on a high-carb diet. Your HDL is well into the desirable range.

However, all of this is really just handwaving - the Friedewald equation is, at best, a crude rule of thumb - and measuring TC during weightloss is about as useful as trying to measure your car's fuel consumption while going uphill, but I get the feeling doctors don't really know or care how their tests work or what they indicate. Your cholesterol panel gives you a very crude idea of what's going on in your body but it has no demonstrable "crystal ball" status, and some of the commonly-asserted cause-effect links are flat-out wrong. People in your age group, for example, are at much higher risk of stroke with low cholesterol than with high cholesterol (or more accurately, people who reach your age and test low TC tend to have a history of strokes, whereas those with high TC do not).

Your doctor will almost certainly push to you take statins because that's what he's being paid to do (he will be penalized by the NHS if he doesn't) despite the fact that your TG and HDL numbers suggest that you're perfectly healthy. What you do with that is entirely up to you. Rather than be confrontational, you might want to ask him "Do you really think these will do me any good? Honestly? Off the record?". A good doctor will smile and shrug and say "um ... probably not".

Anyway, do make sure you're getting adequate fat in your diet. As your body depletes its own reserves, you'll need more fat in your diet to make up the deficit (65-115g net carbs is well into low-carb range).

[TheJazzSinger in reply to TheAwfulToad]

Thank you. I'll let you know how I get on with the doc!

[sandybrown in reply to TheAwfulToad]

Hello,

Very interesting response.

I take it lower triglyceride lower HbA1C?

I am 75, the question is what my blood numbers for my age for blood cholesterol, blood pressure and blood pressure?

Nearly nine years ago I found out I have high fasting blood glucose. I went on life style change. Then high cholesterol was high and now blood pressure.

So far no medication. Only time will tell for medication?

[Dietbunny2 in reply to TheAwfulToad]

Thank you for this TAT - I have just hit 70 and just been asked to visit the doc because my latest blood test indicates a raised cholesterol level (I am already on Ramipiril and Bendroflumethiazide for my BP) and before I visit I will reread you info here - I have no intention of starting on statins as well unless absolutely necessary!