Maarten Vasbinder lives in Isaan. His profession is general practitioner, a profession that he mainly practiced in Spain. On Thailandblog he answers questions from readers who live in Thailand.
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Dear Martin,
I am 58 years old, non-smoker, follow a special diet (keto) because of diabetes, but do not take any medication. Last hba1c was 5,1.
I have been taking statins (Bestatin, 10mg) daily for 40+ years and my levels have always been ok according to the doctor (LDL 133 in 2018). Now I stopped taking those statins last year, and yes, this year my cholesterol was much higher (LDL 360).
I've been following a "keto genic" diet for a few months now, so no big surprise. Only my – recently graduated – doctor immediately panicked. Was I in pain or something? Immediately had to go back on the statins, after much protest (Bestatin 20mg, I have them, but not yet taken). I understand that slightly higher cholesterol levels are not such a problem, but what is acceptable and is high LDL really that bad? Can I Have "Familial High Cholesterol"? So do you have to take statins?
I try to eat a lot of fiber, have stopped alcohol and now go for a walk 2x a day. Will that help? I am going to have my cholesterol tested again soon, but I would like to know what to do?
My “fasting blood sugar” was also high, but hba1c is low, how is that possible? Is that "dawn phenomenon"? I eat earlier every day now, and then my sugar normally goes down.
Regards,
E.
******
Dear E,
Keto diet comes with considerable risks, which you are no doubt aware of. Good guidance is a must. The diet can bring about a temporary increase in LDL and HDL.
I will not go into diets further, because that is a commercial forest, where no one sees the trees anymore.
LDL of 360 is indeed on the very high side. You can have it investigated whether that is familial. Here's an article from the Heart Foundation: www.hartstichting.nl/riskfactors/guide-cholesterol/cholesterolwaarden/erfelijk-high-cholesterol
However, we cannot exclude the possibility of a laboratory error in your case. Therefore, have the determinations repeated in another lab. If it is that high again, then it is time for an internist, who will undoubtedly prescribe statins.
The dawn phenomenon is a common phenomenon. You probably have too. Since I know very little about you, including your weight is a mystery, I can say little more about your diabetes.
Walking is good for you. The value of fiber is often overestimated, but in normal amounts they are very useful.
However, don't panic. Much can be done.
Yours faithfully,
Maarten