"all cause mortality" is a scientific term, and mocking it's definition just shows your inability to interpret scientific results.

I missed the memo when "long term" was deemed 24 weeks. I'd like to live longer than this. At issue with this study is that ALL patients had a BMI over 35. The average age was 42.6 years. I couldn't find any reference to a control group or how many calories these patients consumed. Assuming 4cal/carb, 4cal/protein and 9 cal/fat based on their diet of "20-30g of carbohydrate" and "80-100g of protein"....that's only a 520 calorie/day diet. What fat did they add? This is a very poor study. While all their findings are technically correct, you can't make any assumptions from anything. At 500 calories/day of course BMI, LDL, fasting glucose and everything else is going to drop. This isn't a keto study, this is a starvation study. In fact, the researchers never even reference testing to determine if a patient is "in ketosis".

When I first started looking at the study I intended to debunk it by saying, "well this is a good idea for a 42 year old with a BMI of 35 but not a triathlete in their 30's" but the debunking was done by just reading the actual study and realizing that it has no relation to ketosis apart from references.

I've seen many, many studies on ketosis and it's relation to epilepsy, brain tumors and similar and I've yet to be convinced that ketosis is any better than just a standard calorically restrictive or fasting diet.

I suggest you be more critical with how you gather your information and even more critical with what you suggest, especially when people specifically say they "don't want to start a debate"

LOL. Mark Hyman?

At least you're consistent.

Here are two counter studies worth evaluating. Overall there is certainly a benefit for some in weight loss and many anecdotal cases of improvement in cardiovascular risk factors on a HFLC diet, but there is some pretty compelling long term evidence to counter the 24 week study posted above.

This one is 26 years in women and 20 in men and suggests an increase, not decrease in all cause mortality.
https://www.ncbi.nlm.nih.gov/...articles/PMC2989112/

In addition: Low-carbohydrate diets and all-cause and cause-specific mortality: a population-based cohort study and pooling prospective studies, Mazidi et al. presented at European Society of Cardiology meeting this summer. Concluded an unfavorable effect of LCD on total and cause-specific mortality. Meta-analysis portion included almost 450,000 participants.

Subgroup analysis on a lot of these studies also suggest the trend toward benefit greater with plant based proteins over animal.

I love you guys for having more energy than me to cite references to refute the bs - I start to get up in arms when the misinformation starts flying about and then I worry people will actually think that a nonprofessional opinion holds some weight.

Thanks for taking the time and hopefully the OP will have better perspective on this 'sidetracked issue' of the ketogenic diet. More importantly, understanding the cardiac risk associated with dyslipidemia is exponentially more relevant.

Yeah, but...do you have an online store, where I can, you know....buy stuff that you endorse (maybe for profit)?

No, but seeing the marks out there, maybe it isn't such a bad idea. Here, hold my ethics.

So it is ethical to push the advice of big pharma and studies they fund? How many crestor/lipator/etc ads do you have in your office?

It's ethical to be familiar with the entire body of literature and to analyze or be familiar with critical analysis of major studies. It's also ethical to look into professional associations' guidelines as they typically represent the best information available at the time.

It's funny that you have this picture in your head of evil doctors who are getting paid off by Big Pharma to sell their evil drugs. Are you aware that we can't take a thing from a pharmaceutical company anymore and haven't been able to for awhile? Not a pen, paper, anything. I'm sure you were aware of that though. Kickbacks aren't a thing either, but I'm sure you don't believe me. Ads for meds? (BTW it's spelled Lipitor) Not a one. We don't advertise medicines.

I'd advise you to pull your head out of your ass, take off your tinfoil hat, and quit proselytizing about things you have no actual clue about.

Whenever I see someone writing "big pharma" I think the same thing I think when someone writes "chemicals" or "organic" - ignorance incoming.

Anyone's opinion can hold weight as long as it's backed up by science. I don't care who has the information as long as it's good.

My doc kept harassing me about it because Kaiser pushes it like M&Ms with the only "factor" being over 40 yrs old. I said I did not want to change muscle soreness. So then the doc starting pushing a 20mg dose since it would be so minimal. Finally at a visit I asked what the smallest pill made was. Doc said 10mg so I said I would try that. Keep in mind I literally have no risk factors; but I am over 40. Doc said 10mg was too small to be theraputic. Then why do they make it in 10mg I asked.

Long story short, I started at 10mg for 6 months with no side effects and then went to 20mg and still no side effects. My endocrinologist recommended trying that and I don't know if it made any difference but I did not have any side effects. And the pills worked.

Getting back to the original question. I have been on a variety of statin drugs over the past four years. My cholesterol numbers have always been average to low but since I've had heart bypass surgery my cardiologist wants my numbers very low. When I take the drugs I get very achy, to the point I don't want to get off the coach and move around. I remember doing a marathon at one point and not being able to return to training until I stopped taking the drugs (10 days after). Once I stopped taking the drugs the achiness went away almost immediately. And I was taking a very low dose the the time.

I feel that the choice I am faced with is taking the statins and feeling like I can't exercise or not taking them and continuing to exercise-trying to maintain my health without the drugs. I'd like to know what the outcome is for people who take statins. I mean, if I don't take the drugs am I shortening my life by years? Are there black and white numbers for those who do and those who do not take the drugs?

I'd like to know how others deal with this.

I was in the same boat as you but refused to go on Statins. I did a lot of research and settled on following the guidance in this book. Based on my success I have recommended this program to about 10 people at the office. I kid you not ALL of us have reduced our LDL and total cholesterol by between 20% and 40%. https://www.amazon.com/...ge?ie=UTF8&psc=1

Here are my numbers since following this at the start of 2016.
12/31/2015 - LDL150, Total 245
3/29/2016 - LDL 101, Total 189
11/4/2016 - LDL 116, Total 213
5/19/2017 - LDL 105, Total 195
1/31/2018 - LDL 106, Total 192

Discuss your issues with your doctor and come to a decision together.

Thanks Tom. I have done this and will continue to do this as we meet once a year. I pose the question because I'd like to hear more about about what different people and different approaches have accomplished. I don't mean to demean the medical profession but when I had my surgery I was advised by one of the better hospitals in the country to not eat eggs. Turns out that advise has since been revised. I try to keep an open mind. It seems that the medical profession often has their hands tied by the insurance companies/lawyers. It makes me wonder how our understanding is changing and will continue to change in the not too distant future.

so in this case, you'd have to admit there is an issue...I hope

but likely not, as you are insinuating that I am an ignorant board certified cardiologist

as always, work with your doctor about your risk and choices

after the tender age of 35, EVERYONE's biggest risk of dying is from HEART DISEASE
Use the ACC risk calculator and discuss with your doctor

I am so tired of trying to do the right thing and help all the people who do not seem to take an interest in their own health and know their numbers, what they mean and what to do about it. I have no agenda but it is a fulfilling battle in my office and a futile battle here on line.

I'm glad you have had a good effect in successfully lowering the LDL (and risk).
:)

most cardiologists practice 'evidence based medicine'. some know the literature better than others. medical professionals vary quite a lot in their advice and how good it is...

Of course. But I'm not even diplomatic about it - IMO people peddling dangerous pseudo-scientific crap should be banned from any outlet that gives them a stage. I'm very passionate about this issue stemming from the current antivaxx epidemic. Gullible and ignorant people will believe BS and do not have the necessary education/intelligence to filter the message. Even if it's just one in 1000 believing that "big pharma" is the devil, "organic" is the way, that's already too much. One death is one too much.

I have no idea where you got that from. I didn't say or was even close to insinuating anything of the sort.
What I did say was that in a (scientific if you will) discussion there is no space for calls to authority. Being backed up by science is all that matters. If science supports your claim it makes no difference if you're a cardiologist or a blacksmith.

We agree on the first part. Beyond that,I have no comment other than that my knowledge of the literature is far beyond most.

Heck, if I thought that whacking iron with a hammer and bending it, and then weighing on on important topics was all I needed, I wouldn't have wasted 10 years of my life getting educated in medicine and cardiology. And the 25 years practicing it would certainly have been an added waste. Authorities are actually the ones that are most versed in topics in their specialty, so it actually matters quite a lot if you are an expert in that particular field.

https://healthydietsandscience.blogspot.com/...nd%20Cholesterol?m=0

pretty darn good organizational collection of studies on many topics .


my n=1.

12 years ago total cholesterol 239 with hdl 43. What is recommendation for statins... total > 200 back then?

today: 206, with hdl 100.

My father is on statins. I see the horrible things they have done to him. He is weak, bed ridden, enlarged liver. Are you living life anymore at this point? And still his arteries clog, having multiple stents, from 3 heart attacks. The stents fall out over time... He wont change his diet, believes in the pills as free pass to eat junk

You are having a difficult time understanding.

Feel free to contact me, as I think an honest discussion would be of great benefit.

Look the thing that got me riled up is that he mentioned he tried lifestyle change when now we know it was admittedly half assed

I actually got the "Cholesterol Down" book as well and have been following the majority of the guidelines it has. I am doing that AND now taking the statin.

1.5 weeks into this, I dont THINK I am any more sore, but really, I just can't tell what is "normal" vs statin based soreness.

If, and I mean IF my numbers are WAY down after 3 months, I will take it from there and try to figure out how much of the change can be given to the statin as opposed to my lifestyle changes and new diet based upon the book mentioned.

First things first, I just hope that in 3 months my numbers improve....

If anyone on this thread is curious, take a look at the self experimentation that Dave Feldman over at https://cholesterolcode.com/ has been doing.

The short story is that he has figured a way to manipulate total cholesterol and LDL numbers in about 3 days. It's pretty much on demand and would be an easy way to hit numbers for insurance tests and such.