High cholesterol, starting on Empagliflozin and pondering LCHF diet!

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Nocturnalizer

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Type 2
Hey folks!

I wonder if you can perhaps provide some advice through maybe your own experiences or knowledge that you might have. I'm a long-time Type 2 diabetic with insulin assistance, taking Metformin twice a day. I'm quite overweight (over 22 stone) and recent blood tests have shown that my HB1AC is about 87 and my cholesterol is high. I've been started on a statin to improve the cholesterol and my doctor has asked me to start Empagliflozin again, as I was previously on it in 2019 but stopped due to thrush. I took Liraglutide last year as well and it made me feel so terrible a month in that I gave it up.

So, here's my dilemma: I have long been wanting to start a LCHF diet, and have tested it out in the past and lost some weight, blood sugar levels improved etc. However, from what I've read it can be dangerous to pursue a low carb diet on Empagliflozin due to the risk of DKA. I've not started the Empag just yet as I wanted some advice before I went on it, and if it would affect my ability to be on LCHF going forward. My second issue is that with the high cholesterol is it even viable for me to do a high fat diet? Again, online reading suggests I need to be cutting fat but I know that the LCHF diet is also where I want to go. If it's going to hurt the lowering of my cholesterol that would be problematic.

Does anyone have any advice for what I could consider here, and whether the LCHF diet on Empagliflozin AND with high cholesterol would be workable? Perhaps just doing the LCHF and not taking the Empag would be better? Thank you in advance!
 
When diagnosed I had Hba1c of 91 and was put on Atorvastatin and Metformin. It made me very ill, so I stopped them after a few weeks and relied on LCHF. In 80 days I was no longer in the diabetes range and in 6 months was back to normal levels, my cholesterol went down even though I was not on medication. This seems like the best option for me as I also lost about 50lb - I had been on a low fat cholesterol lowering diet - which had done nothing for my cholesterol and had made me gain loads of weight even though I felt I was starving.
 
Drummer said:
When diagnosed I had Hba1c of 91 and was put on Atorvastatin and Metformin. It made me very ill, so I stopped them after a few weeks and relied on LCHF. In 80 days I was no longer in the diabetes range and in 6 months was back to normal levels, my cholesterol went down even though I was not on medication. This seems like the best option for me as I also lost about 50lb - I had been on a low fat cholesterol lowering diet - which had done nothing for my cholesterol and had made me gain loads of weight even though I felt I was starving.
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That's excellent! That's what I've heard as well. I'm actually on Atorvastatin and Metformin too, and while I don't feel ill from them I DID feel ill from the Empagliflozin. If your cholesterol went down even with the LCHF that's even better news, as that's really my main concern. I don't have to take Empag but I do have to get the cholesterol down.
 
I don't think it was 'even with' the LCHF way of eating - I think it was because of it.
 
Hi. A couple of points. First and I'm generalising here and you must be guided by your GP/nurse. From the info you give, having a LCHF diet is very important. It's not a good way forward to allow medication to deflect from that. If there is a risk of DKA from the Empag then I would suspect a dose reduction might allow you to go LCHF but you must discuss this with the GP/Nurse but stress that you want to reduce weight thru LCHF and that is your priority. Until you lose that weight you will remain in a vicious circle. Second in general the fat you eat does not a have a big impact on blood cholesterol as it's the liver that controls that. Many posters find that LCHF results in better lipids ratios not worse. It's the Carbs that are biggest culprit for weight gain and poor lipids ratios rather than Fat.
 
Everyone is different of course, but I am happy to share my views, having been on Empag for about 2 1/2 months now.

I started at circa 115kg, not following strictest diet ever, but am quite active running and cycling. It has transformed my blood sugar patterns, all much more moderated, significantly less insulin now needed, and I am expecting a significant drop in my next HBA1C from circa 8 to circa 6.5-7 (based on Libre estimate-self funded :() but weight has been coming off at a little more than trickle and am now circa 109kg, so not massive but only been 10 weeks so far.

My view is that provided early doors you keep a very close eye on numbers then there is nothing more to worry about than other combinations of treatments we all try.

Oh, but do make sure you stay well hydrated at all times, otherwise there is the risk of kidney issues as that is how the Empag gets rid of the sugar before it hits the blood stream.

any Q's please ask, I'll help if I can
Malc
 
DaveB said:
Hi. A couple of points. First and I'm generalising here and you must be guided by your GP/nurse. From the info you give, having a LCHF diet is very important. It's not a good way forward to allow medication to deflect from that. If there is a risk of DKA from the Empag then I would suspect a dose reduction might allow you to go LCHF but you must discuss this with the GP/Nurse but stress that you want to reduce weight thru LCHF and that is your priority. Until you lose that weight you will remain in a vicious circle. Second in general the fat you eat does not a have a big impact on blood cholesterol as it's the liver that controls that. Many posters find that LCHF results in better lipids ratios not worse. It's the Carbs that are biggest culprit for weight gain and poor lipids ratios rather than Fat.
Click to expand...

I absolutely see what you're saying. It's why I've been so keen to do LCHF but scared that the medication and cholesterol would be an issue in combination with it. If the LCHF is going to get me those results without the extra medication I'd rather go down that path.
 
BigMalc said:
Everyone is different of course, but I am happy to share my views, having been on Empag for about 2 1/2 months now.

I started at circa 115kg, not following strictest diet ever, but am quite active running and cycling. It has transformed my blood sugar patterns, all much more moderated, significantly less insulin now needed, and I am expecting a significant drop in my next HBA1C from circa 8 to circa 6.5-7 (based on Libre estimate-self funded :() but weight has been coming off at a little more than trickle and am now circa 109kg, so not massive but only been 10 weeks so far.

My view is that provided early doors you keep a very close eye on numbers then there is nothing more to worry about than other combinations of treatments we all try.

Oh, but do make sure you stay well hydrated at all times, otherwise there is the risk of kidney issues as that is how the Empag gets rid of the sugar before it hits the blood stream.

any Q's please ask, I'll help if I can
Malc
Click to expand...


Thanks so much! Have you been on a low carb diet while taking the medication? The water will be no issue as I'm already drinking about three litres a day. Did you have many side effects?
 
Hi Nocturnaizer, Dr David Unwin's patients on LCHF on average reduced HbA1c, Blood Pressure, weight, LDL Cholesterol, Triglycerides and increased HDL Cholesterol. All that on either no or on reducing drugs.
However not everyone on LCHF reduces LDL, though it seems that all or almost all increase HDL and reduce Triglycerides - thus improving their Lipid ratios.

Some like me get an increased LDL on LCHF (however all my ratios are still better). Indeed some get very high LDL on LCHF. Look up Dave Feldman and Lean Mass Hyper Responders.
 
Nocturnalizer said:
Thanks so much! Have you been on a low carb diet while taking the medication? The water will be no issue as I'm already drinking about three litres a day. Did you have many side effects?
Click to expand...
Not a formal low carb diet, measuring things etc, but do try to follow a general low carb ish lifestyle, limited bread, very occasional white only, little pasta or rice etc.
 
I can only comm
ent on one aspect of your question .I had cholesterol levels of over 7 when I was diagnosed with diabetes type 2 but after lowering my carbs and upping the fats I am now 5.2 with good ratios so as an ancient and decrepit old woman I am happy with that 😉
Carol
 
Thanks so much everyone for the great advice! I've decided that I'm going the LCHF route and will not be taking the Empag. I've discussed this with the doctor a few days ago and he's aware that I'm taking this route. The statin has made me feel a bit rubbish to be honest but he's asked me to persist with it every other day for the next few weeks and see how I feel.

Can't wait to start digging into the shopping lists and getting going!
 
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