LDL: What's Optimal For Health And Longevity?

[Dean Pomerleau]

Amla Experiment Results

Results from my wife's 90-day experiment with taking an Amla supplement for her moderately high cholesterol are in. She religiously took two capsules per day (morning and evening) and didn't change her quite-healthy, near-vegan diet or exercise pattern.

Here are her LDL and HDL levels for the last few years, with the last two from May 2021 (pre-amla) and yesterday (post-amla) :

LDL: 130, 133, 133, 126, 116
HDL: 067, 076, 071, 071, 074

Overall we were pleasantly surprised. An apparent drop in LDL of 10-15 mg/dL compared with where it has been consistently for the last few years, along with perhaps a slight increase in HDL after taking an inexpensive amla supplement for three months seems pretty good.

Her LDL is still on the high side, but we've decided to continue with the amla rather than considering a statin for now. We'll reevaluate her cholesterol level in a year.

--Dean

[Ron Put]

I am glad your wife's results are moving in the right direction. But I'd be curious if the trend continues.

My LDL dropped from close to 100 to the 60s after I stopped consuming EVOO at home (still do when out in an Italian restaurant).  It has stayed there. I started taking about 2-3 grams of amla with my meals almost every day over the last half a year or more and have noticed no significant changes.

I believe that you consume a fair amount of EVOO and perhaps your wife does as well. You might want to experiment with cutting out EVOO and other oils at home and see what the effect is.

[Dean Pomerleau]

5 hours ago, Ron Put said:

I believe that you consume a fair amount of EVOO and perhaps your wife does as well. You might want to experiment with cutting out EVOO and other oils at home and see what the effect is

Neither of us consume oils, extra virgin or otherwise. 

--Dean 

[Saintor]

Maybe a bit off-topic but related IMO.   I am looking for data supporting that the upper limit of 200mg/dL TC recommendation might be still too high.   The argument was about 1/3 of people who had a infarction also had their TC between 150-200.   But the disease was almost inexistent for those with a TC less than 150.  I remember having seen that more than 5 years ago, but for a reason I can't put my finger on it.    Or maybe it wasn't  founded.

[Todd Allen]

Yet another study finding low LDL is deadly:

Low density lipoprotein cholesterol and all-cause mortality rate: findings from a study on Japanese community-dwelling persons

Quote

Compared with individuals with LDL-C levels of 144 mg/dL or higher, the multivariable-adjusted Hazard ratio (and 95% confidence interval) for all-cause mortality was 2.54 (1.58–4.07) for those with LDL-C levels below 70 mg/dL, 1.71 (1.15–2.54) for those with LDL-C levels between 70 mg/dL and 92 mg/dL, and 1.21 (0.87–1.68) for those with LDL-C levels between 93 mg/dL and 143 mg/dL.

 

[Ron Put]

19 hours ago, Todd Allen said:

Yet another study finding low LDL is deadly

Hm, looking at the second table, the low LDLs are also more likely to have hypertriglyceridemia and hyperuricemia. I'd also be curious if they are insulin resistant.

See this:

High triglycerides, low HDL cholesterol and a low LDL cholesterol per apolipoprotein b ratio predict incident diabetes in patients with established coronary artery disease

[Todd Allen]

13 hours ago, Ron Put said:

Hm, looking at the second table, the low LDLs are also more likely to have hypertriglyceridemia and hyperuricemia. I'd also be curious if they are insulin resistant.

Yes, I think context is everything.  Statistical findings for any given biomarker across a cohort or population may not hold for a different cohort.   Looking at very different cohorts producing very different results is desirable.

[Dean Pomerleau]

On 9/9/2021 at 2:21 PM, Dean Pomerleau said:

Amla Experiment Results

Results from my wife's 90-day experiment with taking an Amla supplement for her moderately high cholesterol are in. She religiously took two capsules per day (morning and evening) and didn't change her quite-healthy, near-vegan diet or exercise pattern.

Here are her LDL and HDL levels for the last few years, with the last two from May 2021 (pre-amla) and yesterday (post-amla) :

LDL: 130, 133, 133, 126, 116
HDL: 067, 076, 071, 071, 074

Overall we were pleasantly surprised. An apparent drop in LDL of 10-15 mg/dL compared with where it has been consistently for the last few years, along with perhaps a slight increase in HDL after taking an inexpensive amla supplement for three months seems pretty good.

Her LDL is still on the high side, but we've decided to continue with the amla rather than considering a statin for now. We'll reevaluate her cholesterol level in a year.

--Dean

It's been a year since the last update on my wife's experiment with taking amla for her modestly elevated cholesterol. Unfortunately her LDL has gone back up, despite religiously taking two amla capsules per day for the last year. Here are her latest numbers (blue):

LDL: 130, 133, 133, 126, 116, 125
HDL: 067, 076, 071, 071, 074 077

So it looks like the drop in LDL she saw after three months of taking alma (green) was either a fluke or the cholesterol lowering effects of alma were short lived.

Oh well...

--Dean

[InquilineKea]

LDL has minimal (non-significant association) with GrimAge -https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8805309/ . low HDL-C and high-TG accelerates midlife epigenetic aging

 

I saw from two other studies (diagrams) [one by a student of Wyss-Corey] that its correlations with clocks of proteomic/epigenetic aging were VERY slightly negative (not significant though).

It's oxidized LDL, VLDL, and Lp(a) that we should be worried about.

https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0185307

 

Edited November 8, 2022 by InquilineKea

[Guest]

21 hours ago, Dean Pomerleau said:

It's been a year since the last update on my wife's experiment with taking amla for her modestly elevated cholesterol. Unfortunately her LDL has gone back up, despite religiously taking two amla capsules per day for the last year. Here are her latest numbers (blue):

LDL: 130, 133, 133, 126, 116, 125
HDL: 067, 076, 071, 071, 074 077

So it looks like the drop in LDL she saw after three months of taking alma (green) was either a fluke or the cholesterol lowering effects of alma were short lived.

Oh well...

--Dean

 

Maybe your SO can try a statin? According to a recent study, it seems more effective than common supplements:

https://www.tctmd.com/news/common-heart-supplements-cant-beat-statins-sport

 

If she has statin allergy (a common health condition among supplement users and "alternative science" community), she could try a hydrophilic statin (e.g. Pravastatin or Rosuvastatin), as in clinical studies they generally have less side effects.

[Dean Pomerleau]

15 minutes ago, Guest said:

Maybe your SO can try a statin? According to a recent study, it seems more effective than common supplements:

Yes, I saw that. We had hopes for amla since it had at least a couple successful randomized trials. But no dice.

I too think she may want to consider a statin, but first I think she's going to try cutting out / way back on olive oil. That's the one thing she eats regularly that might be raising her cholesterol. But she is APOE4, making her cholesterol level very stubborn.

--Dean

[mccoy]

18 hours ago, InquilineKea said:

It's oxidized LDL, VLDL, and Lp(a) that we should be worried about.

Others (Dr. Peter Attia) insist all day long that APOB cholesterol is what we should be worried about. Maybe that's near to the fraction you cite. Oxidation is not cited though.

But after all LDLc is a subset of APOB and is used as a proxy. Non-HDL cholesterol is another useful proxy for those who don't have access to APOB direct measurements. Also, excessive precision is probably hardly achievable ro sensible in these fluctuating quantities.

Edited November 8, 2022 by mccoy

[Dean Pomerleau]

1 minute ago, mccoy said:

Others (Dr. Peter Attia) insist all day long that APOB cholesterol is what we should be worried about.

I listened to his "Women and Heart Disease" podcast today and heard the same thing - APOB, which includes LDL and VLDL, is what has been shown to correlate with CVD risk.

[mccoy]

Just now, Dean Pomerleau said:

I listened to his "Women and Heart Disease" podcast today

I have yet to listen to that podcast, in the first instance I discarded it since I reasoned I'm not into the women subgroup, but now I realize being egotistical and having a duty to report to the wife. The APOB issue seems to remain identical across genders though.

[InquilineKea]

It's the LDL particle sizes that matter A LOT.

Also can't antioxidants help prevent the cholesterol from getting oxidized?

[mccoy]

15 hours ago, InquilineKea said:

It's the LDL particle sizes that matter A LOT

I don't know, until a while ago even Peter Attia used to debate on particles size and number, then he seemed to switch his attention to the whole APOB fraction. In the chaos ruling the lipids arena, I prefer a single, simple benchmark, lest I loose sight of my garden when concentrating too much on each single blade of grass...

Again, LDL-C and non-HDL cholesterol are still probably considered decent proxies of APOB but the next time I'm going to have a thorough check I'll make sure to include APOB

[InquilineKea]

 

[Guest]

@ InquilineKea:

you're posting results from an observational study; while there is some value in them - especially large scale, well controlled ones - they generally are less reliable than clinical RCT. You often have problems with reverse causality, biases, or unobserved confounders - depending on the factor at hand. A supplement that is not a natural factor in the human diet is somewhat "cleaner" to disentangle. A blood marker that can be influenced by a variety of factors is more problematic.

 

But we DO have large scale clinical RCTs for LDL interventions in a broad variety of patient groups (age, gender, (lack of) co-morbidities etc.). A lot with 5 years of clinical trial and some up to 10-15 years of follow up data (so up to 20 years in total). All these placebo controlled trials demonstrate, that lower LDL particle concentration is generally beneficial.

 

And we have a good understanding why the RCTs found these results, based on the cellular/tissue process of arteriosclerosis. This process is well understood and matches the narrative that lower LDL is better.