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An alternate way to interpret and optimise your cholesterol levels (not LDL or ApoB)
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- čas přidán 14. 08. 2024
- LDL “bad” cholesterol and total cholesterol may not be as helpful to focus on as the fasting triglyceride to HDL “good” cholesterol ratio, when it comes to cardiovascular disease and health in general. I go through lifestyle tips to optimise your levels, and more importantly improve your metabolic health, reduce vascular inflammation and reduce insulin resistance. I also discuss LDL subfractions and ApoB.
Buy The Concise Nutrition and Lifestyle Guide: www.bosanqueth... (available worldwide via Amazon).
More on LDL and total cholesterol: • Key cholesterol study ...
General nutrition: • The Victorian era diet...
Animal Fat: • Why ANIMAL FAT is the ...
Help your sleep: • Artificial light is DE...
Help your stress: • 5 ways to reduce stres...
Graphs used from: www.ncbi.nlm.n... Is LDL cholesterol associated with long-term mortality among primary prevention adults? A retrospective cohort study from a large healthcare system by Kevin E Kip, David Diamond, Suresh Mulukutla, Oscar C Marroquin, used under creative commons license. creativecommon...
Qrisk3 calculator: qrisk.org/inde...
Ratio for identifying metabolic syndrome: www.ncbi.nlm.n...
Ratio for identifying metabolic syndrome and cardiovascular disease: www.ncbi.nlm.n...
HDL as an antioxidant: www.ncbi.nlm.n...
Fasting triglycerides: www.heartuk.or...
Insulin resistance and triglycerides: www.ncbi.nlm.n...
Comparison of triglyceride glucose index and HbA1C as a marker of prediabetes - A preliminary study: www.sciencedir...
Relationship of ratio to small dense LDL: www.ncbi.nlm.n...
Nutrition and ApoB: www.cambridge....
Lipid levels in patients hospitalized with coronary artery disease: an analysis of 136,905 hospitalizations in Get With The Guidelines: pubmed.ncbi.nl...
Cholesterol confusion and statin controversy: www.ncbi.nlm.n...
My doctor said since I refuse to take a statin there's no reason for him to even order a lipid panel blood test. I said "OK". But later I realized, wow! That was a tacit admission that he ONLY looks for opportunities to sell drugs, not for problems in my health.
Just don't go to doctors. They are largely just a bunch of pill pushers. If you have an accident and need to get some stitches or whatever then they are going to get you patched up but they have less training than the average large animal veterinarian in nutrition. If zoos or farms had animals requiring medication or dying at the rate humans are these days ,they would all be fired at the best or criminally charged with malpractice and stripped of credentials. They have covered their asses by getting congress to pass laws to make it impossible to sue them. Would you trust your car or home to a professional who was above the law and couldn't be sued for damages?
No better than a dealer on the corner
@@melkerner kind of worse in some ways, because the dealer on the corner doesn't pretend that they're trying to improve your health
You need a different doctor.
@@darvoid66 Well, it would be worse if he wanted to see me all the time and run tests to see what else he could get me to take.
I was on statins for quite a few years..."Beautiful" low total chol values but triglycerides were unacceptably high. I started doing some of my own research, trashed the statins in 2019, went on HFLC (very low) eating plan, lost 15 kg in weight and have never felt better. During some blood tests done very recently, my readings were total chol 4.8 mmol/l, HDL-C 1.9 mmol/l, LDL-C 2.5 mmol/l and trigs 1.2 mmol/l. The purpose of the tests was not primarily to test my lipid panel, so I was not fasted. That could explain the higher than normal Trig level, which usually is well below 1.
And I eat roughly 60-65/30/5-10% for fat, protein and carbs respectively.
Statins are poison, full stop!
The best way to fix your cholesterol is raise the guidelines back to what they were in the 70's. There, now you don't have high cholesterol.
Ha ha ha good point!
They changed it to sell more drugs!❤
@@charlesstuart1119 Bingo!
Ten years ago a Veterans Afairs doctor in the US tried to tell me that my LDL was high & I needed to take statins. When I attempted to explain that the Total/HDL ratio was more important he only got louder. My wife was appalled that I'd argue with a doctor. I'm in my late sixties now & still don't take them. I cycle, ruck, & backpack in the mountains regularly. Oh, and I no longer use the VA medical services.
I found your last video about this topic by accident this morning and was so impressed I subscribed, and then watched this second video immediately. This video, in terms of the message across to more people, is even better so I've just shared it on Facebook. Really excellent video! Thank you!
Thanks a lot!
This video succinctly recommends what to focus on. Well done Philip. It is a blizzard out here in lipid-land. Even the Lipid specialists within large practices in the US cannot agree on what is actually causing death from MI and stroke. If i had to cite only one common thread that seems to be agreed upon by the most thoughtful analysis of the available literature - it would be metabolic health - AKA diabetes - pre diabetes etc - and are the commonly accepted values actually reflecting the problem. My wife is a fellowship trained endo and has said for a long time that the A1c accepted levels (5.5ish -5.7ish as 'normal range' ) to be inaccurate - that if you are 5.0 or above you are exhibiting metabolic impairment. Low carb and anything else seems to be her mantra. No 'fast carbs' in particular. Sorry so long. Happy 4th of July to US !
Thanks for your comment. I agree with your wife on the range of HbA1c - higher end of "normal" range is not ideal. As well as diet, most people will need to get exercise, sleep and stress all in order to get those lower HbA1c figures - definitely worth striving for.
@@drphilipbosanquet Also worth pointing out that HbA1c is not the be all and end all either, you can have a "normal" A1c made up of glucose spikes followed by dips, as my glucometer showed me.
Good stuff anyway and it's nice to see a young doctor following in the footsteps of the old guys I used to follow on blogs. Especially in the UK. Please try not to get cancelled!
Nicely done. Well explained and easy for the layman to understand. Personally my triglycerides dropped like a rock when l quit drinking so l would definitely encourage anyone who is even a light drinker to give it up.
Thanks, and nice one with the trig reduction.
Yes, and always remember that fructose is every bit as chronically toxic as ethanol at similar dosages.
Very useful to have the UK values reference. Thank you.
No worries, glad that was useful.
There is no cause and effect between LDL and CAD. It´s the turbulence in the arterial system caused by higher BP and glycation due to consumption of Carbohydrates that causes the damage in the endothelial cells. LDL is just there to fix the membranes that are composed primarily of Cholesterol.
Well explained! Short and to the point! ❤
Correctamundo!
Hubby & I started changing our lifestyle last March, from SAD to a form of KETO, but we still eat beans of every kind. I make my own: butter, salad dressings; cook everything from scratch; no sugar, flour, pasta, white rice/potatoes; no eating after 7:30 pm; no processed foods; olive, coconut, MCT, or avocado oil, increased flax, psyllium husk, chia seeds, and no eating out. Use raw milk to make homemade Greek yogurt, and buy free range eggs from a friend. And we fast lots ... maybe eat 10-12 meals a week, with our longest fast thus far being 72 hours!
The savings allow us to buy veggies/ meat from an organic farmer, plus I can/ pickle/preserve everything that comes off my huge garden. We started in March, 2023, I'm no longer insulin resistant, hubby was taking 60 units a day of insulin, and is now down to under 60 units/week! We walk 30 mins a day, and do weights 2x a week. And we're each down 80 pounds in weight ~ to put that in perspective, we were feeding 160 pound person between us ... think of the money we've saved! Spring forward to this May, when I saw my regular Doctor. He of course did my bloodwork, and freaked when he saw my cholesterol. I just calculated my Triglycerides/HDL, and my risk came out 1.6, and there is ZERO heart disease in my immediate family. I’ve never smoked, done ANY street drugs, don’t drink at all for the past 10 years or so, but did drink a bit before that. So, the doctor insisted I needed statins, ordered them up for me, and I’ve decided I’m never taking them. My daughter is a pharmacist and she said the same as the doc “you need statins”. I’ve been doing KETO, have cut out sugar, white bread products, potatoes, pasta, and have been eating butter (home made), full fat yogurt, homemade, cream, sour cream etc. So, IF I have to go back to the SAD diet, take statins, eat crap food to make my doc happy, well let’s just say he is going to be miserable, because I’m not, and I’m never taking statins either.
Thanks for sharing, and I love to hear big turn arounds like this with your sort of lifestyle interventions. That is the way to go. Hope it keeps going well. Also - raw milk for homemade greek yoghurt - what a win!
Thank you so much for your response! We’re both feeling so much better and I hope he’ll be off his diabetic medication after his next appointment. Bless you, and keep the videos coming. So glad I found you in my feed and started following you! Bella
@@Bella-gj6wc Thanks a lot, I really appreciate that.
Brilliant post. Much more important than the money you've saved is the quality of life you've regained. Sorry to read that your daughter is just as deluded as your doctor, both among many medical and pharmaceutical professionals dancing to the destructive tune of the Big Pharma Pied Piper.
The colour of the rice doesn't matter. They both turn into sugar in the body. Same with bread.
Excellent explanation. thanks. And how refreshing to have a UK based health / nutrition advice source!
Thank you, glad you found it helpful.
I pay attention to my triglycerides and blood glucose that tells you how healthy your metabolism is.
Fasting insulin would be even a better marker... Because high insulin is CAUSAL to heart disease, T2D, cancer, dementia and many more...
Please look at CRP, Homociestine and omega-3 blood index. If those are not optimal your body will suffer needlessly.
@@JohnnyRocketone my crp and homocystine are good tested in may. I eat plenty of fish im not concerned about omega 3
Those are certainly critical measures, especially if you are limited to few test.
Nice summary of the key points. I've seen these figures elsewhere but not so nicely summarised. The triglycerides to hdl ratio is also supposed to be a good surrogate for the concentration of small dense ldl which is suggested as the main culprit in cvd.
Thank you, glad you liked it
Your presentations are most informative, thank you. Also, good call in including both American and UK units - this helps a lot. Finally, with a TG/HDL = 0.2 (UK based) I remain convinced that my doctor's laminations concerning my high LDL are unnecessary and that Keto remains the healthiest option for me.
Same! I was sent to a dietician "for my cholesterol". She was obsessed with cutting fat out of my diet and replacing it with more carbs. This made my lipids worse and I rapidly gained 15kg all around my gut. She accused me of "failing to comply" with the diet when anyone with half a clue could see the diet was failing to comply with me. Long story short, when I actually ate the opposite of what I was told I doubled my HDL, reduced my trigs to between 1/5 and 1/10 of what they were, stabilised my blood glucose, reduced my blood pressure and lost all the weight again. So who cares what my LDL is? 19 years of low carb/keto and no drugs and I'm still alive which I clearly shouldn't be. Farmer not pharma.
Thank you Dr. B for your insightful summary - and for answering questions in the comments. At last it all makes sense!
That's fantastic to hear, and thanks for your comment :)
I am a nurse. I never was over weight and always ate low fat as the health industry told us to do which was completely wrong.
When my total cholesterol was 215 and my doctor wanted me to go on a statin, I said no thank you, I’ll take care of it. I stopped eating, sugar, processed carbs, and seed oils. I now eat grass fed beef, wild caught seafood, extra virgin olive oil, pasture raised eggs & chicken, organic veggies, leafy greens etc. and exercise of course. I was able to lower my total cholesterol to 189. HDL is 77 and triglycerides are 49. Apo b is 70. LDL cholesterol is 98. I think those lab values are all good now, but why does my lipid panel show my LDL particle number too high? LDL small and LDL med are too high. How can that be?
The new "RECOMMENDATIONS" are next to no grass fed delicious meat and more seed oils. F#ck em, they are lying.
Last night in the pub my friend said his doctor had talked about him taking a statin. I said I'd forward to him your last video (40 years hidden data) which I was looking for when this video popped up. Both are *EXCELLENT* and very concise. Full of facts and devoid of waffle. Thank you.
Thanks a lot. There will be a statin video coming the video after next.
Thanks, great video.
Hba1c tends to be high for long term carnivore due to longer lasting red blood cells, according to Dr Paul Mason and several others, so in this scenario it's over estimating the average blood glucose. This also needs to be taken in to account.
Very interesting, yes running on slightly different physiology can demonstrate limitations of these markers.
Oh that's interesting, yes I recall some diabetics showing higher or lower A1c than their spot numbers suggested. There's an alternative test for glycation I can't remember the name of but in the UK it's only available to vets.
A year ago, I was diagnosed with T2D with a HbA1c of 6.6%. At the time, my Triglycerides were high, my HDL was low and LDL was in the normal clinical range.
I immediately started researching and embarked on a low carb diet with plenty of eggs, dairy, red meat and fish. Immediately my weight dropped by 7kg. My HbA1c dropped to 6.1% and is trending down. My Triglycerides dropped to 80mg/dL. My HDL increased to 42mg/dL. All good. But my LDL went up to 150mg/dL (ApoB 127mg/dL). I'm 59 and have a BMI of 27.5, so I'm hardly a LMHR.
My doctor was concerned about the raised LDL and urged me to cut red meat and saturated fat. I decided to have a CT Angiogram. The results have just come back with a CAC score of 0 and no signs of any plaque deposits. The cardiologist has recommended that I continue doing what I'm doing and review it in 3-5 years!
I know that atherosclerosis is a slow process, but my body's had a full year with "high cholesterol" for it to start developing. But yet the score is 0!
Congratulations.
there are multiple reasons why LDL will go up in both the short and longer term. Day to day there can be substantial changes to LDL, weight loss and raise LDL during that phase and lower LDL during weight gain phase etc. LMHR is just a fanciful group, one that helps put low carb diets and high LDL on the map as still being healthy, but because of the spotlight it has damaged the thinking around high LDL outside of LMHR is still an issue.... as you showed your moderately high LDL isn't.
Lifestyle improvement is always the answer. It is the only answer for improving health span. Unfortunately in the UK, our GPs are so overworked that it is easier to prescribe pharmaceutical interventions to lower biomarkers than to advise and follow up on changing patients poor lifestyle choices. I realised this through self education, hopefully not too late in life.
Completely agree, and yes a lot easier and quicker in the 10 mins you have to do a prescription, rather than try to completely unpack mainstream nutrition advice and convince them that alternate lifestyle changes can make rapid changes to how they feel (why would they believe you when the calorie restricted diet they were previously recommended was near impossible and ended in failure?).
@@drphilipbosanquet my personal history backs up this. Diagnosed with T2DM over 10 years ago their answer was increasing the doses of medication and sticking to the NHS (high carb low fat) recommended diet. It wasn't until I radically changed lifestyle, IF/TRE low carb dieting and walking everyday + resistance training, that the "biomarkers" such as A1C started to come good. Now into a year of "normal" values I have difficulty convincing them to withdraw the metformin and statins.
Overworked 4 day week?
Thank-you so much for this data and placing it within the context of hazard ratios. As a 74-year old woman, I was alarmed by my "high" LDL reading of 177 mg/dL. But my HDL is super-high at 119 mg/dL. And my triglycerides are low at 75 mg/dL. Also, my "dense" LDL is low at 11 mg/dL. Thanks again!
So as long your insuline, triglycerides, glucose and A1C is normal there's nothing to worry about ? I'm 24 and my LDL was 150, HDL 54, triglycerides 90, A1C 5.2 and glucose 90
My pcp wanted to prescribe low doses of statins but i said no I'm ok. I'm not keto or carnivore I'm just tryng to eat lean and less carbs but i eat carbs like veggies, low glycemic index fruits like berries, cherries, avocados and kiwi. and i also go to the gym and work in physically demanding job
all good stuff, thanks!
Another reason to minimize blood glucose spikes is to protect our vascular endothelial glycocalyx - our shields.
This is incredibly interesting, thank you.
That's great to hear, thanks. Your comment is much appreciated.
Love the explanation on why to fast for triglyceride test. Never knew!
Glad it was helpful!
My LDL is 196. My apob is118.
My trig/HDL is 2.1
My hsCRP is 0.9 mg/L
My fasting glucose is 70 mg/dL
My fasting insulin is 2.9 uIU/mL
My A1C is 5.1
My BMI is 17.8
All of my other 35 measured labs are perfect. Only my LDL and apob are high.
I'm fine.
If get a good 2-3 hr bike ride in before my lipid blood draw I can raise my HDL 20 points.
Nice one Doc. Need more younger Doctors like yourself promoting the actual data rather than staying on the outdated Pharma train of getting everyone over a certain age (here in the UK at least) on Statins - generally without even a lipid panel check! Meta analysis I read showed Absolute risk reduction at less than 1% anyway, yet it’s the most prescribed medication in the World, whatever happened to logic?
Oh yeah, money got in the way..
That's an excellent point; even most GP's don't know the difference between 'Absolute' and 'Relative' RISK - hence even they get hoodwinked by pro big pharma studies that are presented in ways that often Overplay Efficacy whilst simultaneously Underplaying Dangers!
@user-dw3sf5qz1q Drs are not the smartest of people, keep that in mind.
You are a great educator! Subbed :)
Thanks a lot!
What about the importance of bio marker of Lp (a). I had mine tested and it is elevated.
Same… my physician was willing to monitor my high cholesterol (familial high cholesterol diagnosed when I weighed only 100lbs) and ran several marker tests. The only one she had a concern about was the high Lp(a) so she recommended that I take a statin 3 times a week as my paternal grandmother died of a heart attack at 54 (she was a smoker) and my father had extensive cardiovascular disease as a direct result/side effect of a type 2 diabetes drug. My friends dad had extremely high Lp(a) and lived to be 92
I wish I knew more about diet, nutrition and health when I was young. My doctors sure didn't help with that. It's the accumulation of nutritional abuse over years that exacts a high price and the later years. It's never too late to make changes ... radical changes to eating habits and choices.
Great video. I still struggle go find a cardiologist here in Asia who is willing to look into that HDL/Triglycerides ratio and properly explain why he thinks that view is just "fancy". Instead, he is still keen to fall on prescribing cholesterol lowering drugs.
Same in the UK. We used to have a lab that actually measured rather than estimated LDL. The new lab had an el cheapo analyser that didn't report trigs. Several others elsewhere reported the same. When I queried this my doctor said "We don't need to know trigs because we don't have a drug for that!" Yet they need to measure them to calculate LDL.
I had recently blood tests for hba1c (I’m in the pre-diabetic range varying between 40 and 42) and the cholesterol panel. My GP called me in because my LDL was “high” and insisted I have statins. I had already worked out my HDL/Triglyceride ratio and it was 0.85, he wasn’t interested in my questions when I insisted that my LDL wasn’t overly bad. I did try Atorvastatin about a year ago but they gave me problems, so, as a compromise he gave me Ezetimibe instead this time. I have been doing time restricted eating for the past year (18/6) after finding that my hba1c was 68 in June 2023 and do 7 hours at the gym 3 days a week doing resistance training and 16 km on the bike. He said that because I’m pre-diabetic it’s essential that I reduce my LDL.😮
Trig/HDL of 0.85 is awesome!
what is essential is to gain control of the glucose if you are a diabetic... that doctor sounds like he had pharma induced brain rot.
@@scottw2317 the problem is insulin resistance. High serum glucose is just a symptom. Glucose isn't a problem, the fact that it can no longer be sequestered in tissue is the problem. The reason it can no longer be sequestered in tissue is because the bodies tissues have stopped reacting to insulin because they have had a lifetime of overstimulation by insulin.
To reverse diabetes (which *is 100% reversible*) one nust simply stop the continuous overstimulation with insulin. This means fasting and a lifestyle change to daily fasting (aka intermittent fasting).
Also almost everyone who has insulin resistance is also suffering from fructose poisoning and must cease the consumption of fructose to allow the liver to recover.
It is possible to develop insulin resistance without fructose poisoning but the two conditions are almost always comorbid in practice.
@@homomorphic Insulin Resistance is not measured in the clinic, you can get a modelled response but we know how great models are at predicting what is actually going on. Thus using IR is a construct.
There are also instances where Glucose goes up without the accompanied Insulin response (Dawn Effect) and times where Insulin is elevated without any increase in glucose in the blood stream such as in most people who work nights and this is without fructose.
I don't overall disagree being keto/carnivore for going on 5.5 years now.
@@scottw2317 There are circadian impacts that affect metabolic response. Circadian rhythm influences many aspects of human biology. Circadian response can have negative health impacts, if temporal behavior patterns diverge from evolved patterns. Circadian disruption can even be a factor in development or insulin resistance, but circadian anomalies such as the dawn effect are evolved responses and are perfectly normal (unlike insulin level anomalies that result from disruption of the circadian rhythm).
My doc said I had borderline high cholesterol. A statin was suggested based on family history. We had some back and forth and she said to get a calcium score and that calcium deposits and/or plaque buildup is a better indicator of how healthy your arteries are. BP is good and resting heart rate is low for my age
A rare insight for what to consider when faced with "numbers" alert given by medical field anxious to provide statins. Will listen to your series to formulate questions and answers prior to agreeing to the statin recommendation on the table. Wish I had a better background in pharmacutical language.
Good video. Would have been great if you explained how to calculate the triglyceride/HDL ratio from typical UK test results and what the target values would then be…..
ideally its triglyceride at 1 divided by HDL at 1.55, result being 0.66. But I think anything less than 1 is considered good
You may convert your lipid panel results to the US units and then calculate the ratio. A bit of an extra hassle but unit conversion calculators are easy to find on the internet.
A fair ask though.
So clear & concise!
Thank you, that what I aim for so really pleased it comes across that way!
So, what are the benchmarks for the Triglycerides/HCL ratio, using UK units?
Very clear pointers. More people should hear about these healthy facts. 👏🇦🇺
Thanks a lot!
Thanks for straightforward and simple explanation plus practical recommendations.
Love your comment about changing lifestyle instead of pills to improve our biomarkers.
Thanks for your comment, and glad that you appreciated that :)
I appreciate your expertise. Helps a lot!
I think dr paul mason has been saying this for years
So, if a family member has high total ch of 6.5, low trig of 0.5, high HDL of 1.7, would that mean they have nothing to worry about? Their Dr. is pushing for statins. Thank you!
Just as LDL is not increased by intake of cholesterol, I don't think that HDL can be increased by intake of "good" fats. Eating things like fish are certainly healthier compared to the standard junk food diet. What I suspect raises HDL is that when in a fasted state, with minimal glucose in the blood, the body needs to retrieve fat from storage for energy use. This causes the LDL to go up as it is the transport mechanism of fat from adipose tissue to the cells. As part of this, the liver needs generate some glucose from fat via gluconeogenesis. HDL is the transport carrying fat from the loaded LDL to the liver. This is likely what drives HDL up. So the more the carb deprived state of the body, the higher the HDL (to a point).
What do you think of Dr Gil Carvalho's video "Don't be fooled by RATIOS like Triglycerides:HDL-C" ?
What is considered a valid level for fasting in terms of hours
I have low cholesterol throughout my life (independent from diet). Overall Cholesterol is 143, HDL 48, Triglycerides is 63 and LDL 95. I smoke cigarettes, but zero alcohol. Age group is 45 years.
I eat mostly processed food, mostly meat and dairy rich meals, eggs, sometimes fish, few vegetables and no fruits. I don't have a car and do everything on foot or riding an old fashioned bicycle. Last heart check and ultrasound was fine, other blood values have been in the mid range of the norm scale.
So i doubt that cholesterol is a result of lifestyle, i think it's genetically, the number doesn't matter, the body sets the number on its own.
Why can't be both?
My doctor wanted me to take a statin because of my ldl and I said no ways because my triglycerides were as low as 0.7mmol.
Thank you!! Focusing on this now! Went to doctor this morning and they pushed statins again. Brought up the risks and he said they outweigh the alternative. He even said they don't have ldl/hdl figured out completely. By raising HDL and lowering triglycerides does it help blood pressure too?
Would love to see a video about how to stabilize and/or reverse artery plaque without stains! Thank you for all of your research on this topic.
Thanks a lot! The same steps for raising HDL and lowering triglycerides should help blood pressure, a lot of overlap. Of course BP could be all due to single factor like stress. I would also emphasise exercise and movement as well for helping raise HDL and reducing high blood pressure.
Ive given up sugar, chocolate, cholestrial tablets. I eat alot of my own honey, bees not sugar fed. I was told the sweeteners are very bad. A doctor on utube said the difference between wholegrain & white bread as far as diabetees is concerned is minimal. The fasting over night is something ive never heard about.
Regarding the last remark, see: autophagy
Now I am confused. My gp wanted me to take statins I refused.
I am in Australian female 56 years old. I follow carnivore diet, no dairy, no sugar or processed food. I walk daily and do pilates. Fast 14 hours a day. my cholesterol was total 7.3, trigs 1.8, hdl c 1.8, ldl c 4.7, ratio 4.1. Can anyone tell me if this is good or not?
trigs should be kept below 1.5 from memory but statins are not used to fix that. If you had a test just prior to the diet change to indicate if there has been a substantial change in the trigs number. Overall though there is little concrete science on any of these measures. A few things to check is if you have elevated blood glucose in the morning (often referred to the dawn effect) a common issue to do with cortisol rising in some people and not lowering glucose until you eat. Fasting might be better eating earlier in the day and breaking that fast around breakfast, but I don't know if that will have much impact on trigs. Other aspects are that some pastoral genetics do better with enough calcium (animal sourced) in the diet, this also helps with glucose control and perhaps trigs. Sources for calcium outside of dairy can include small boned fish like sardines (if eating sardines not canned varieties will have more oxidised oils and the tinned packaging contains machine oils) a couple of times a week or powdered egg shells.
Another great video Philip 👏🏼
Thanks a lot!
My LDL is 4.4 HDL is 2.03 Triglycerides 0.7 , from what you say I have no need to worry about my LDL ?
For a number of years I had my annual checkup in winter. More often than not I had low vitamin D and high cholesterol levels. Taking vitamin D capsules seemed to do absolutely nothing, neither did taking statins. One year I decided from April, I would go for a walk at lunchtime with my shirt sleeves rolled up (on sunny days) to get a boost for my vitamin D levels and what do you know, when I went for my checkup both readings were in the normal range. Years later I found a research paper on the relationship between cholesterol and vitamin D levels. (Very simple explanation) When the sun hits your skin it breaks down cholesterol in your body and produces vitamin D. Lower cholestrol levels, higher vitamin D levels. Problem solved. Since then I have not had high cholesterol levels or low vitamin D levels.
I am looking for an online website to put HDL LDL etc
Daily exercise, quality sleep and emotional health is important.
To achieve the desired TG/HDL ratio, I can: either increase HDL, or decrease TG, or do both. My guess is, the latter is the best option. But, if I only increase HDL while TG stays the same and it may be even above the norm, is it still good? I'm just concerned when ratios are used in diagnostics without considering the numerator and denominator on their own in terms of their impact on health.
Good point re ratios and yes I agree it is good to look at both as individual figures, which is what I also prefer to do.
From what my study and resulting lifestyle changes have revealed this doctor is spot on!
So then as long as my HDL is high, my Triglycerides low, my Triglycerides/HDL ratio is good based on your charts, should I completely ignore my level of LDL in my blood test?
I would never completely ignore a reading, LDL in the graphs provided by that paper shows a U-shaped pattern when correlated to mortality. If very high then that is something that would be assessed by a lipid clinic for things like hypercholesterolaemia, prior to that cut off it is a discussion with a doctor in context of other biomarkers and your general health.
So thankful to get a view from a UK doctor. I am on Letrozole for breast cancer (despite the NHS Predict tool giving me only a survival benefit of 0.9% over 15 years on endocrine treatment) which apparently raises cholesterol so my GP has raised my statin from 20mg to 40mg per day. Can I ask candidly, do GPs in the UK make treatment decisions based on NICE recommendations only? How long is the lag between results from studies such as those you reference being included in NICE recommendations? My HDL needs to increase but triglyceride level is 1.5. Yes I have more work to do on lifestyle improvements but it would be helpful to be able to do that without the side effects of drugs that I’m being urged to take because of a sweepingly generalised protocol handed down by a slow-moving organisation. Thank you for these short, punchy videos.
Thanks a lot for your comment. I would think a lot of GPs run on their clinical experience, but yes, the NICE guidelines are pretty much it. I certainly look at the NICE guidelines for just about everything unless I am very up to date on it. I have no idea about the process of the NICE guidelines construction, they do site their sources as to how they came to their decisions, but of course these are not personalised recommendations and also most studies limited by being conducted on a generally metabolically unhealthy population.
Simple common sense. Great video
Thanks a lot
Excellent video! Thank you.
You're very welcome.
5:05 What is the reasoning for recommending "fiber"? Or, what is the science for recommending fiber? I recently watch a lecture from Dr Paul Mason (Australia) saying that fiber recommendations were based on opinion, not on research. Maybe you have some insight he may have missed. By your recommendation, I would think you lean toward keto, and I believe Dr Paul Mason is mostly carnivore. Overall, I'm not surprised by what you say in the first 5 minutes of this video, as it echoes a lot of keto-carnivore doctors I've been watching/following. Though the specific recommendation for "fiber", instead of "low carb veggies" in a larger sense is surprising. If the focus is "fiber" (an anti-nutrient, since it slows and even block the absorption of macronutrients (and very likely their micronutrient contained within), and the focus is not the vitamins and micronutrients from vegetables, I have to assume your recommendation for "fiber" is based on hard evidence demonstrating their importance for health. I imagine you will answer something about "gut microbiome", but then those bacteria thriving on fiber must be very special, but in what way? I've recently watch a video of a 3 months experiment from a ketovore advocate going carnivore (he went back to keto after the experiment), and a heart surgeon and his "mentor" were both thrilled to see his results from "healty" to "healthier" at the end of the experiment. I know, n=1, but still.
If you want to look at Dr. Paul Mason presentation I was mentioning above, it is available on CZcams on the Low Carb Down Under channel, it is 6 years old (so maybe there is new evidence that would change his stance on the subject) and is titled Dr. Paul Mason - 'From fibre to the microbiome: low carb gut health".
Though I'm currently doing carnivore, I don't mind ketovore since it is already so much better than the standard western diet, and I would recommend keto to friends and family members who would be scared of going full carnivore (can't blame them, the brainwashing was real)
I consume loads of natural fats ghee ,butter, greek yoghurt, cheese, jersey cow milk, EV olive oil, fish oil. I avoid everything fat free and low fat. Im not perfect as I do indulge in sweets & pizza which are my vices.
Sounds good, I dodge anything labelled 'low fat' and the like. The only time I check calories on the label is to make sure I'm getting the product with the most calories (whole foods of course) - I want to get my moneys worth!
If you dont have insuline resistance, t2d or inflammatory there isn´t any good reason to lower your LDLs. Those causes oxodized LDLs ans small LDLs that are those bad LDLs.
Your body and every single cell needs LDL for building block for regenerating new cells.
So without those problems there is no reason to lower your cholesterol. If you do that, it only slows your healing process.
Thanks, interesting topic. Is it possible to do an explanation for those in Australia.?
I cut out all processed food and only ate natural high fat organic wholefood. My ldl went ftom 3 nmol to 6.8nmol
My triglycerides stayed at 0.8 and hdl shot up to 2.37. What do i do (uk measures)
There was a study done on HDL, it showed that many people died with higher level of HDL. any explanation for this. Thanks 🙏👍
Zero requirement for fibre.
Low triglycerides and HDL is very consistent with insulin sensitivity. But trigs and HDL not best markers re atheroma growth aspect of the cardiovascular axis. High triglycerides and low HDL is consistent with potential inflammation of, more than growth of, atheroma - for that I thought you were going to mention ApoB and Lp(a). Those two are the king markers of atherosclerosis risk as it relates lipids
I’ve been on healthy keto for a year with IF and my HDL is high and trigs are super low.
Thanks x
You're very welcome :)
Superb video, doctor. What if someone has a CAC score over 400 but all the other values are fine?
My ldl is 55, trig 55, hdl 39 total c 105 apob 54, how can i raise my hdl. BMI 21
Im still so confused. I was told my cholesterol is getting to high.
My trig is 0.59
Hdl is 1.7
LDL is 3.6
Is this good or bad? Im in Australia if that changes how results are listed.
I had bloods done and my total cholesterol plus my LDL was high, all other bloods were normal.
Dr immediately wanted to put me on statins, I said No, after some words as to why I did not wish to go on statins. We compromised, I would make some lifestyle changes and try to exercise more. Revisit in 3mths
Didn’t really believe there was much food wise I could improve on. However I am trying to exercise more.
I am a slow acetylator, fasting bloods were done after 9:45hrs not 12-14, wondering if this could make a marked difference to my levels?
Great post. Question. If calculating a ratio the units cancel out. Shouldn’t make a difference to the ratio in the UK if units are the same top and bottom, No?
It's because the conversion factor is different for triglycerides because UK uses mmols which means the conversion factor alters for each molecular weight (if I recall my chemistry correctly??). In otherwords the same unit has a different conversion factor depending on size of the particle involved. You'll see that on the conversion calculators they have to separate trigs from the others (eg www.omnicalculator.com/health/cholesterol-units).
@@drphilipbosanquet Thanks. That was an interesting journey in to converting and realising that the ratios are not the same when you convert to a different unit!
GREAT STUFF😊
Thanks a lot!
I think there is a fault. 60mg/dl is not 1.55mmol/L but 3.33?
I will correct myself. It looks like the conversion for glucose is different then for chloresterol.
My doctor wanted me to try a statin but I had a side effect. She said that it would help prevent vascular dementia, which is what I am more afraid of.
dementia (all kinds), MS, Parkinsons and particularly ALS incidence increase in people who take statins. The 'risk rate' for ALS is over 11000% higher in statin users for example, the other diseases are much lower.... but you get the drift.
How long do you have to fast before a fasting triglycerides measurement/blood test? (I already fast for at least 16hrs/day but I usually start late and finish late, first meal around 16:00 and last around 22:00, sleep around 01:00-02:00
12 hours (from the last bite of your last meal) should be good.
@@drphilipbosanquet Thanks!
from people testing blood tests you need to test within about the 12-14 hour window, doing a fasted blood test outside of this seems to indicate a much greater variation in results.
Where did you get your chiropractor degree from?
Thanks for the video - very helpful. I came across this searching to improve my understanding of the numbers following a routine GP check up that resulted in advice to take statins. I was a bit surprised as I consider myself very active, fit and healthy with a good diet. Blood pressure is normal (120/81), waist is smaller than it has been for about 30 years (73cm), a BMI of 20.4 and at 54 years a VO2max higher than my age (just about). The figure they seemed to be most concerned about was triglcerides of 1.9 as they flag anything over 1.7. This wasn't a fasted test though and I was interested to see that your discussion mentions fasted levels. When I mentioned that I have increased dietry fat/reduced carb over the last few years and had a high fat breakfast (inc. full fat yoghurt, nuts, seeds) a couple of hours before the test this was dismissed as irrelevant. Do you think these tests still need to be done fasted for accurate results?
Fasted and fed tests are different. Sort of like doing fasted blood sugar test and postprandial blood sugar. Both have their roles, but certainly different. I'm unsure of how a fatty meal could be considered irrelevant though.
@@drphilipbosanquet Thanks for the reply. That was my thinking but I was told NHS don't do fasted tests anymore as its not necessary... I couldn't see how it was irrelevant either but I'm not medically trained so just end up feeling confused. Needless to say, I haven't taken their advice to go on statins though.
@@paulwhitehorne8292 Hadn't heard that one! My tests were all fasting except once my GP wanted to see non-fasting numbers, which weren't actually that different. I mostly eat a small low carb breakfast and a main meal between late afternoon and late evening which is high fat moderate protein low carb. I presume the assumption is that everyone eats high carb low fat three meals and three snacks per day.
I haven't seen them for about ten years since my (fairly) good doctor left and one of the idiots who remained told me categorically I had never had a glucose tolerance test, so they nor only removed the results from my file but even the fact that I had the test. This proves there was never anything wrong with me so I couldn't possibly have improved my health. If I wanted to see them I probably couldn't, except for "my vaccine" which I never took eight times. I think they only recently stopped enforcing muzzles.
@@paulwhitehorne8292I fast before my blood tests - I don't wait for the GP to tell me to (they won't). I just take charge of it myself.😊😊
Been on Carnivore for about 3-4 months now to heal from IBS, except I bake with Erythritol on Saturdays. Had bloodwork done 2 weeks ago and since Dec, my Tryglicerides went up from 79 to 167, HDL from 59 to 71, LDL from 139 to 556. I did do cardio that morning and fasted for at least 11 hours. I was very shocked! I weigh 139 lbs, BMI is 21, Body fat 4%, lot of lean muscle mass. Lift weights 6 days a week and cardio aboit 25K-30K steps per day. I normally eat 80/20 hamburger in the morning, 9 eggs per day, 4 oz salmon, 4 oz fatty steak and 2 chicken wings. Don't know why my Tryglicerides are so high. Maybe it was the Erythritol, cardio before bloodwork, or did not fast long enough. I will retake it but wondering if anyone has any thoughts on this?
Maybe check out Dave Feldman and triglyceride carryover on CZcams. I honestly don't know as have no real clinical experience with people on carnivore but I have heard him talk about this.
if that is your bodyfat I wouldn't be surprised something is going to be off. I'd expect your BUN etc to be elevated as well. You shouldn't be spending much time at all around that bodyfat %. There is a video by Dr Cywes about 'saladino is right' or some such. Look at the guy Cywes is talking about, his numbers and ignore his advice on fixing that. Yes using that method can mask what is happening but all he is suggesting is eating more but made it carbs which is not as helpful as he claims. Essentially as a guess I would say your body is breaking down protein for energy (glucose) due to how lean and how much exercise you are doing. Body builders rarely spend long below 10% bodyfat.
Now adjust the LDL or APOb graphs for metabolic health, and the relationship becomes linear.
Good job!
Thanks!
What about Ldl after CABG?
Except for age (73) and sex (male) none of the known risk factors could be associated to me: no overweight (182 cm, 76 kg), lots of sports, no smoking, 120/80 blood pressure, healthy nutrition, no stress, no diabetes, ... Nevertheless some chest pain and few weeks ago: a cardio CT revealed 50-75% stenosis. Shit happens.
Indeed it does - and very sorry to hear that. I hope you have a speedy recovery so you can get back to your sports.
@@drphilipbosanquet The recovery turns out to be difficult. The doctors want the proof of ischemic risk before setting a stent. Otherwise „Let’s wait“. However, I am a scientist, Professor for Biochemistry, and had been working for 25 years with pimary human endothelial cells, exploring EC physiology under the influence of mechanic stimuli (M A Freyberg 1, D Kaiser, R Graf, J Buttenbender, P Friedl Biochem Biophys Res Commun. 2001 Aug 10;286(1):141-9 „Proatherogenic flow conditions initiate endothelial apoptosis via thrombospondin-1 and the integrin-associated protein“) and know that this guideline is dubios. The plaque will not disappear in contrast it will show further growth due to its thrombogenic surface. On the other hand it is obvious for me that the risk of restenosis should correlate withe plaque seize: the balloon catheter presses the plaque into the vessel wall punching a big whole into the endothelium creating an thrombogenic area. Adjacent EC will migrate into this area and start proliferation finally closing the wound and restoring the athrombogenic surface. The period of time with a thrombogenic surface should correlate with risk for restenosis. So for me it seems stupid to wait. However the guidelines ….
Try keeping your OxLDL below 60.
Get yr cholesterol size checked out. Big fluffy cholesterol is very good n tiny is bad-gets into artery lining. I’m goin to do this test cuz I have family history of heart disease.
Sorry that's an answer for below
Risk calculators used by GPs around the world don't look solely at total and LDL cholesterol. In fact, few of them even look at LDL. The Australian guidelines for example includes the ratio of total cholesterol to HDL. Are you saying that the trigs to HDL ratio is superior to the various calculators used by GPs? The point about LDL is that it is a well studied risk factor and lowering LDL has been shown to reduce MACE.
Indeed, same as here in the UK with the Qrisk3 calculator mentioned - total:HDL ratio. However, in reality, many doctors still focus more on LDL even though risk calculator is not taking that into account as a single figure. The downside of a ratio: high total and high HDL could give same ratio as low total and low HDL. Same result, but different clinical pictures. You can also improve ratio by lowering total cholesterol whilst not doing anything to boost your HDL. That study shows better correlation for trigs:HDL ratio, and trigs are important, so I think if using total:HDL ratio, you should still do trigs as well - but this is now rarely done in the UK.
@@drphilipbosanquet Thanks. I understand that various trials in
which HDL was raised showed no MACE benefits. Results from triglyceride lowering trials have been mixed I believe. It's perhaps understandable then that GPs focus on interventions that have demonstrated significant benefits in key target groups?
I also understood that full lipid profiles ordered by GPs included triglyceride measurement (but I am just going by NG238).
@@tomgoff7887 It depends if you're referring to trials where HDL was raised by a drug (I am aware of these not having the desired effect, but that's the problem with focusing on a biomarker) or those seeing a correlation with increased HDL in conjunction with lifestyle changes eg more exercise (I'm not aware of these studies)? Benefits in drugs of course tend to be against placebo (pretty low bar?) and rarely trialed against lifestyle interventions, and are also unable to establish other long term consequences unrelated to the disease being focused on. In the UK, cholesterol tests are rarely done fasting now, so no fasting trig.
@@drphilipbosanquet Thanks but still the point remains that there is no solid evidence that raising either trigs or HDL reduces MACE whereas there is such evidence that LDL lowering reduces MACE. That is my concern about your argument here and why I am having problems getting my head around your reasoning. But thanks for your thoughtful replies.
@@tomgoff7887 Trying to improve overall metabolic health and I think HDL and trig are better indications of that than LDL when approached from lifestyle interventions. Trials involving metabolically unhealthy people of limited value if trying to optimise health. Lowering LDL in context of metabolically unhealthy patient could for some have positive impact if it's impacting the inflammatory process, but is missing the root cause and not as useful as lifestyle changes. Also, LDL lowering usually means statins and these have mixed evidence base and tend to put people off bothering with lifestyle changes (also, statins main mechanism of action may well not be related to LDL, this is in the 'discussion' of the cited paper). Often when patient's are shown this NICE page, they are not convinced. www.nice.org.uk/guidance/ng238/resources/patient-decision-aid-on-should-i-take-a-statin-pdf-243780159
Make OX-LDL ,lipoproteinA,Omocysteine,Hs-CRP ,and plac test....all from blood.😊😊😊
Old dying patients don't eat, so their ldl gets lower and lower until they die. Why couldnt that explain the whole raise on lower ldl levels?
Hey Doc, do you think we should be having fasted blood tests for assessing cholesterol? I've just had a blood test (unfasted) and told by text my cholesterol is slightly high but not seen the detailed results yet. I see there are fairly new recommendations that we don't need to fast before a blood test. Feels to me though that someone's trying to engineer tests so more people show high cholesterol and they can then prescribe more statins. 🤔
Unfasted bloods probably fine for total:HDL ratio. I think fasted trig also useful though so fasting makes sense to me.
Very interesting. My doctor says that my triglycerides are high but I have never had fasted triglyceride level tested.
Carbohydrates elevate triglycerides cut your carbs!!
Lifestyle changes focus on improving general fitness, too simple for those medicos to believe!! 😢
You are wrong. HDL is very hard to move. CRP and Homociestine is much more important than HDL!
You don't need to interfere with your cholesterol at all. Leave it alone. Those with "low" cholesterol have a higher mortality rate than those with "high" cholesterol.
😊DAVIE THE DOCTOR OR DAVIE THE DEALER?😢