I recently read this blog post by Michael Aviad about his experience with doctors and the perspective that statins are crucial to reducing cardiac risk in diabetic patients. I commented on it as concisely as I could, but I think I'll expand on it here.
My doctor recommended that I take statins last summer because my Total Cholesterol was above the acceptable range for a diabetic. It was fine for a non-diabetic.
Why do diabetics have a lower ideal number than non-diabetics? Risk factors... Because, generally, diabetics tend to have higher triglycerides and higher A1Cs than normal people, which also carry a greater cardiac risk profile. Abnormal A1Cs typically correlate with high LDL counts.
I did some research about statins and found a couple of facts about the relationship of all these things to each other and came to some conclusions.
- Statins are anti-inflammatory, which can reduce risk for inflammatory health problems, like heart disease. Some experts even say that the benefits of statins might be more from the anti-inflammatory characteristics than the cholesterol lowering effects.
- High blood sugar is inflammatory, which is a risk factor for inflammatory health problems.
- Insulin also inflammatory. Insulin resistance is a sign of hormonal imbalance and inflammation.
- Eating low-carb reduces the need for insulin and increases insulin sensitivity. Needing smaller amounts overall helps achieve tighter glucose control (Dr. Bernstein's "rule of small numbers".
You could say that they kind of cancel each other out. But... if you can manage to keep your blood sugar normal... then you have activated an anti-inflammatory change and improved your risk. I chose to aim for that, and skip statins. Plus, research has shown that if you lower your A1C score, your LDL count will often descend with it. I'd rather work with something I've had 26 years practice with. Sounds like good glucose control is the winner all around. I'm not saying it's easy, but, it's possible.
Also, about LDL cholesterol. There is a correlation between LDL cholesterol and triglycerides. If you have high triglycerides (from eating a lot of carbs and sugar) then your LDL particles are likely to be dense and be plaque forming. If your triglycerides are low, then your LDL particles are more likely to be large fluffy particles that resist forming arterial plaques. Your LDL isn't considered dangerous if you also have low triglyceride numbers.
As a low carb eater my triglycerides are very low. My A1C is getting closer and closer to normal, non-diabetic numbers. With these two arguments, I told my doctor that I wasn't going to take the statins and risk their side-effects. He agreed with my choice. Another doctor, on the floor at the hospital in December, tried to put me on statins without even meeting me, and I also refused that offer.
I'm much more interested in discipline and knowledge than in a preventative drug. I think we have the information to make wise individual decisions for ourselves in this matter. Look at all the facts, and check out all the opinions. I don't consider myself to be the average diabetic or statistic. So the collective opinion of doctors created for the average statistic, isn't necessarily a good fit for me.