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Statins, plaque and arguing with doctors: can y'all help me prepare?

Commented on June 22, 2015
Created October 29, 2011 at 8:08 PM

My husband and I recently went in for a consult with a doc who we heard from local paleo loops was pro-paleo. Indeed, he had Cordain's book in the waiting room. After talking with him, I think his partner/son is the more paleo dude, but he was still sharp, clearly a guy who isn't just checking boxes on a form. Many things I agreed with him about, and he wasn't afraid to have a conversation/discussion/argument.

However (isn't there always a however?), I had numbers to take him, and my cholesteral is high. It was in the high 200s, and then a few weeks later in the high mid 300s. (My ratio is good, HDL is pretty high, but LDL is also high). At any rate, I told him I wanted VAP run to look at particle size. He wasn't opposed to that, but wants me and my husband (who used to be on statins, but weaned himself off) to get the CT Heart Scan that will actually look at your arteries and see if you have plaque. Then we can proceed from there.

So we decided to do that. I mean, can't argue with the fact that knowing if there's plaque in your arteries would be information you can use. The test is next Friday.

If there's no plaque, his thinking is continue as usual (I'd still want the LDL particle size test). If there IS plaque, he'd recommend statins, and he also said that I'd want to no longer have my saturated fat breakfast of steak, eggs and bacon.

And therein lies my sticky wicket. I said that there is no causal link b/w sat fat and CVD. He sort of agreed and sort of shifted the subject. His response was essentially that he doesn't care about the cholesteral number. But if there is plaque, then statins essentially put a protective coat over the plaque (my words, not his) so that it doesn't break off and cause an infarction.

Sort of a, well, if you'd been paleo all your life you would have been fine, but you lived for years on Triscuits, got plaque, and now you need these drugs approach.

To me, that makes no sense. It seems to me that a paleo diet--at least to the extent it results in fluffy LDL rather than oxidative LDL would have the same protective impact and possibly (since the fluffy dudes are like the clean-up crew as I understand it) reduce accumulated plaque.

I'm looking to be educated on this. He seems like a doc more than willing to a) let me/us do what we want, and b) a doc willing to read articles and studies.

I haven't found anything on PH that talks about paleo and statins in the context of arteries that are already known to have plaque. I found a vague mention of reducing plaque w/o statins on the Track Your Plaque blog, but nothing in depth.

I'm happy to read whatever is out there, but I need help finding it. Does anyone have any insight into this issue? Thoughts of their own? Links to articles? When we get the results of the tests, if there is plaque, I want to go in well-armed, knowing ahead of time how I want to proceed and feeling confident about my decision. And if there is no plaque, I'm now interested enough in the question that I still want the education.

Thanks!

EDIT:

Digging deeper, I have now found a number of references on Track Your Plaque (and on PubMed, but I can't figure out how to get the full articles, only the abstracts), that suggest that a) plaque is reversible and b) statins do not significantly reduce the risk of heart attack with patients who already have plaque, c) statins do not decrease the rate of plaque "growth", as compared to dietary changes (ie, paleo), and d) plaque can be reversed via diet.

I know that the diet referenced is high fat, mod protein, low carb (pretty much my diet now). And that supplements (niacin, vit D3, vit K2 and Fish Oil) are utilized. I read a blog that covered some research suggesting ketosis provides the same benefit as the niacin w/o the toxicity concerns. I'm already supplementing w/ D3 and K2 and was supplementing w/ fish oil and can certainly start up again.

My instinct was to say no to statins, and this supports that instinct. I still want to know what "high fat" means in regard to the TYP diet, but I'll wait to join that site if it turns out the CT Scan shows that plaque is present in either me or my husband.

We will get the VAP of course to make sure the LDL is fluffy (esp me, since my count is so high), but if not, I've already been given some great advice in an earlier post for how to convert B to A in the context of paleo.

Thanks everyone. If anyone has more articles that address the statin/pre-existing plaque issue, I'd still love to see links. If anyone has details about Track Your Plaque's diet recommendations, I'd love to hear that, too, though that's probably better as a new question.

3bf1b60e858d84a7e90ce2bfb14b5702

(0)

on June 22, 2015
at 02:19 AM

Fascinating post! Could you share the references that you found. I know you don't have the whole articles but I'd love to look up the abstracts. Thanks! 

Medium avatar

(10611)

on November 02, 2011
at 04:27 PM

Well I'm guessing that you don't chase ambulances in Illinois. On the provider side it's a big concern, and carrying malpractice is gradually being pushed down from doctors through the whole health care staff.

E06dcdb3f856057025e9776e038d8072

(305)

on November 02, 2011
at 02:17 PM

Well, yes, but as an attorney I also know that I don't HAVE a case, so why on earth would I be filing a malpractice suit? That makes no sense. Doctor + unwelcome result = malpractice suit just isn't the way things work (or should work).

E06dcdb3f856057025e9776e038d8072

(305)

on November 02, 2011
at 02:15 PM

You're right, of course; definitely something to keep in mind.

Medium avatar

(39831)

on October 31, 2011
at 06:02 PM

If you've done those tests that recently, you're probably OK. It sounds like you're already doing everything right and should be fine. There are a lot of things that we suspect cause cancer, but ionizing radiation is one of the few things that we know does. Something to keep in mind.

Medium avatar

(10611)

on October 31, 2011
at 05:54 PM

What are you missing? If the dr prescribes a statin and you have a cv event, you'll lose your case if you weren't following his orders. That's why he prescribed it - if he doesn't use standard med protocol he's liable. The solution is to find a dr that doesn't prescribe statins (good luck on that) or skip the dr altogether.

E06dcdb3f856057025e9776e038d8072

(305)

on October 31, 2011
at 03:34 AM

I have no idea what you're talking about. You're saying I should argue with my doctor by saying that I'll sue him for malpractice????? For doing what??? Malpractice is negligence. No matter how I or anyone in the paleo community feels about statins, recommending them to someone whose cholesterol numbers are high or who shows plaque on a CT scan would not qualify as malpractice. (Not to mention the fact that I'm not "answerable" to my doctor at all, for following his prescriptions or not--I mean, it's not like my doc can sue me for making my own decision). I'm really not following you...

E06dcdb3f856057025e9776e038d8072

(305)

on October 31, 2011
at 03:25 AM

The air quality where I live is good (except for natural allergans) and I've never smoked, but LOL re moving. Would that it were so easy. I take 6000 iu of Vit D daily and 1000 of K2 m-4 about every 2-3 days. I used to have a pretty nasty arrhythmia and had a mitral valve prolapse diagnosed a few years ago (that diagnosis was later reversed). Had stress tests, echo, ultrasound, the monitor thingie for arrhythmia. No mention of plaque at all, but whether that's b/c they didn't look or it was negative, I don't know. Will call and ask on Monday, though.....

E06dcdb3f856057025e9776e038d8072

(305)

on October 31, 2011
at 03:23 AM

Appreciat the input. I get what you're saying re the radiation level, but it doesn't worry me greatly. I rarely eat butter, and very minimal cream. I mostly cut it out about 4 weeks ago, I think, but even before that wasn't eating that much. Primarily I'm CO only these days. My triglycerides are lowish (87)....

0dbd7154d909b97fe774d1655754f195

(16131)

on October 30, 2011
at 06:55 PM

http://www.youtube.com/watch?v=GqdzJLOQM2I&feature=related

Medium avatar

(10611)

on October 30, 2011
at 04:18 PM

Yes it's your personal decision to go rogue on your prescriptions. But don't expect to find Cordain, Sisson and Taubes by your side when the malpractice suit is tried.

13a44ea00b0c9af0b6d0f3d5f5c2cfca

(7223)

on October 30, 2011
at 12:58 PM

Well, according to this info and other info I've read there is never any benefit to women from statins regardless of circumstances.

E06dcdb3f856057025e9776e038d8072

(305)

on October 30, 2011
at 01:45 AM

Thanks...I'll check these out. Some look familiar. I've read a lot about statins and cholesterol etc., but it's that additional question of the benefits vel non of statins after plaque as opposed to merely lowering cholesterol.

6120c989fd5b69f42a0834b69b87955b

(24553)

on October 29, 2011
at 09:44 PM

I don't know where to send you, but supposedly there is no benefit in the use of statins in women.

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6 Answers

4
Medium avatar

on October 30, 2011
at 05:07 PM

So we decided to do that. I mean, can't argue with the fact that knowing if there's plaque in your arteries would be information you can use. The test is next Friday.

I disagree; I think you can argue with unnecessary dosages of ionizing radiation.

For your LDL to rise that quickly, you pretty much have to be eating a lot of dairy fat from butter and/or cream. Just stop doing that and it will plummet.

As far as plaques go, they're largely the result of LDL or VLDL becoming oxidized and invading the arterial lining. You can prevent them by keeping LDL low-ish and by greatly reducing your serum triglycerides (which itself will greatly increase HDL). The rise in HDL will increase your ability to transport the cholesterol from any plaques you do have back to the liver for recycling. High triglycerides are thus doubly bad because they increase the likelihood of a plaque and they inhibit its removal. Most Americans have a very high intake of calcium and a very low intake of D3 and K2. This causes arterial calcification, which promotes artery hardening and the formation and eventual rupture of plaques.

A good strategy overall is to:

1) Stop eating butter and cream

2) Keep serum fasting triglycerides under 50 (not 150 like a doctor might tell you) via walking in the fasted state and a reduction in alcohol, fructose and MCTs.

3) Increase antioxidants so that those lipoproteins you do have circulating don't become oxidized. Supplement with vitamin C, get vitamin E from pastured egg yolks/raw nuts and make sure you eat a lot of meat so that you get plenty of sulfur-containing amino acids for the production of glutathione/GSH.

Edit: 4) Related to the above, in addition to increasing antioxidants, you want to decrease oxidative stress. This means don't even think about smoking and if you live somewhere with polluted air (specifically heavy ozone concentrations) move ASAP.

5) Take vitamin D3 (5000iu or so) and K2 (100mcg) every day to prevent/reverse the calcification of your soft tissue. If that heart scan comes back with a lot of calcification you're going to have to do this anyway in order to reverse it. I think overshooting on K2 for a while is likely advantageous since the toxicity is so low and the likelihood of calcification is extremely high for most people coming from the SAD.

Edit 2: I'd be extremely surprised if an echocardiogram couldn't reveal plaques to a cardiologist. No ionizing radiation and it shows your heart actually in action so you could discover a congenital defect/bad valve etc. as well. I've had one before, and I must say that it really puts your mind at ease regarding fears of dying suddenly due to an arrhythmia or defect of some sort. Downside? Costs the insurance company more money.

Good luck.

E06dcdb3f856057025e9776e038d8072

(305)

on October 31, 2011
at 03:23 AM

Appreciat the input. I get what you're saying re the radiation level, but it doesn't worry me greatly. I rarely eat butter, and very minimal cream. I mostly cut it out about 4 weeks ago, I think, but even before that wasn't eating that much. Primarily I'm CO only these days. My triglycerides are lowish (87)....

E06dcdb3f856057025e9776e038d8072

(305)

on October 31, 2011
at 03:25 AM

The air quality where I live is good (except for natural allergans) and I've never smoked, but LOL re moving. Would that it were so easy. I take 6000 iu of Vit D daily and 1000 of K2 m-4 about every 2-3 days. I used to have a pretty nasty arrhythmia and had a mitral valve prolapse diagnosed a few years ago (that diagnosis was later reversed). Had stress tests, echo, ultrasound, the monitor thingie for arrhythmia. No mention of plaque at all, but whether that's b/c they didn't look or it was negative, I don't know. Will call and ask on Monday, though.....

Medium avatar

(39831)

on October 31, 2011
at 06:02 PM

If you've done those tests that recently, you're probably OK. It sounds like you're already doing everything right and should be fine. There are a lot of things that we suspect cause cancer, but ionizing radiation is one of the few things that we know does. Something to keep in mind.

E06dcdb3f856057025e9776e038d8072

(305)

on November 02, 2011
at 02:15 PM

You're right, of course; definitely something to keep in mind.

4
13a44ea00b0c9af0b6d0f3d5f5c2cfca

(7223)

on October 29, 2011
at 08:38 PM

Chris Kresser has a lot of good info on the problems with statins including a summary of statin research to take to your doctor:

http://chriskresser.com/images/statintrialsummary.pdf

http://chriskresser.com/the-hidden-truth-about-statins

http://chriskresser.com/the-truth-about-statin-drugs

Chris Masterjohn has an entire website devoted to cholesterol myths. You may be able to find information about how to reduce/eliminate already existent plaque there.

http://www.cholesterol-and-health.com/index.html

E06dcdb3f856057025e9776e038d8072

(305)

on October 30, 2011
at 01:45 AM

Thanks...I'll check these out. Some look familiar. I've read a lot about statins and cholesterol etc., but it's that additional question of the benefits vel non of statins after plaque as opposed to merely lowering cholesterol.

13a44ea00b0c9af0b6d0f3d5f5c2cfca

(7223)

on October 30, 2011
at 12:58 PM

Well, according to this info and other info I've read there is never any benefit to women from statins regardless of circumstances.

1
Medium avatar

(10611)

on October 30, 2011
at 04:13 PM

Have you considered malpractice in your arguments? If you have a CV event, for any reason, your doctor does not want to see you in court. Ultimately you'll be answerable for not following his prescriptions.

E06dcdb3f856057025e9776e038d8072

(305)

on October 31, 2011
at 03:34 AM

I have no idea what you're talking about. You're saying I should argue with my doctor by saying that I'll sue him for malpractice????? For doing what??? Malpractice is negligence. No matter how I or anyone in the paleo community feels about statins, recommending them to someone whose cholesterol numbers are high or who shows plaque on a CT scan would not qualify as malpractice. (Not to mention the fact that I'm not "answerable" to my doctor at all, for following his prescriptions or not--I mean, it's not like my doc can sue me for making my own decision). I'm really not following you...

Medium avatar

(10611)

on October 31, 2011
at 05:54 PM

What are you missing? If the dr prescribes a statin and you have a cv event, you'll lose your case if you weren't following his orders. That's why he prescribed it - if he doesn't use standard med protocol he's liable. The solution is to find a dr that doesn't prescribe statins (good luck on that) or skip the dr altogether.

E06dcdb3f856057025e9776e038d8072

(305)

on November 02, 2011
at 02:17 PM

Well, yes, but as an attorney I also know that I don't HAVE a case, so why on earth would I be filing a malpractice suit? That makes no sense. Doctor + unwelcome result = malpractice suit just isn't the way things work (or should work).

Medium avatar

(10611)

on November 02, 2011
at 04:27 PM

Well I'm guessing that you don't chase ambulances in Illinois. On the provider side it's a big concern, and carrying malpractice is gradually being pushed down from doctors through the whole health care staff.

1
F3583667d653163c121640a015ffa93a

(784)

on October 30, 2011
at 12:11 PM

Tell him you'll get the VAP test and go by what it says. Would be interesting to know,anyway, wouldn't it?

1
36015f7365538d2006024bfdb60e4c15

on October 29, 2011
at 08:59 PM

The Chris Kresser links are sure to be full of good info - he is always spot on (IMO). Also, the MD can still recommend you take statins based on all the blood work and tests; however, you are the patient and you get the finial decision about what you put in your body! You obviously don't want to be reckless and endanger your health but once you get all the info you need, I am sure you will make an informed decision.

Medium avatar

(10611)

on October 30, 2011
at 04:18 PM

Yes it's your personal decision to go rogue on your prescriptions. But don't expect to find Cordain, Sisson and Taubes by your side when the malpractice suit is tried.

0
Cf4576cbcc44fc7f2294135609bce9e5

on December 26, 2011
at 09:30 PM

statins cause muscle damage. the heart is a muscle. yea good luck with that.

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