Cholesterol - management of high cholesterol

Nutrition
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Guess it is unsurprising that on a forum full of active cyclists there isn’t loads of discussion about cholesterol, but it is surprising to only see one or two references (they seem to be people having their bloods checked as have a family history of high cholesterol).

I am not asking for medical advice at all, just very interested on if anyone here has high cholesterol and then how it has been managed.

Primarily how have people managed it with eating extra things (co-workers have anecdotally recommended walnuts), but what else have they cut out to make an impact?
Secondary, given my situation, what medication has been prescribed and did it work or have any other impact?

As background the doctor I have been seeing for the last 3 years has been monitoring but taken no action, just encouraged exercise. He was pretty relaxed about it as I had no other health factors that concerned him.
I saw a new doctor today and they suggest medication might be the best option. Again no other health factors of concern but that my cholesterol has been ‘high’ for 3+ years regardless of diet and exercise is enough for him to say it is likely genetic and pointing out why wouldn’t I treat it if I can?

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A few questions:

Can you define “high” in terms of what parts are high? (LDL, HDL, Trig, etc) and whether you are just above or significantly above?

What’s your body comp look like? (Bf %)

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Hi, just waiting for the more detailed results to come back from the appointment today. Last time around it was:

HDL 1.5 mmol/L
LDL 4.34 mmol/L
Trig 1.67 mmol/L
At that point I was a shade over 20% bf ~85kgs (13stone 5lbs) at 5’10"

Since then my weight is down to just over 80kgs (12 stone 9lb) and I haven’t lost any height. I believe my bf % is ~18%, HDL is down and LDL is up.

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I’m not a Dr. nor an expert on this subject but I had a similar discussion with my Dr.

He said that you can genetically have high cholesterol but not be at risk. Statins like you are describing seal the plaque that you have inside your arteries but don’t remove what’s already there. They just make it more difficult for additional plaque to accumulate. He told me I could get a scan and figure out if I’m actually at risk and should be on meds or if high cholesterol is just genetic and nothing to worry about.

Artery Scan Info

I’m sure there are more knowledgeable folks that can describe this better than I but that’s the quick summary conversation I had with my Dr.

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I’m a typical “genetic” case - lots of physical activity, good eating habits. Changing what I eat has zero impact on my LDL, which is somewhere around 4mmol/l. Not overweight, not perfect either (BMI below 25, but not by much). Been taking minimal statin dosage for a couple of years, it does drop my LDL below the recommended 3.5 threshold. It also does affect my ability to recover from hard workouts, be it running or cycling, but it’s quite manageable. We could have a long discussion on whether the statin-induced reduction in cholesterol level reduces risks or not (high LDL levels are correlated with higher incidence of cardiovascular illness, statins are correlated with lowering LDL levels, but there is no correlation between statin-reduced LDL levels and a reduction in cardiovascular diseases). But it is what it is.

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My take? The evidence for statins is poor. The best case for them is made for secondary prevention of a cardiac incident, ie you’ve already had a heart attack. The number needed to treat to avoid a 2nd heart attack is still pretty high, and only barely reduces mortality. In other words you might, maybe, avoid a 2nd heart attack but you weren’t any more likely to die from it anyway even if you weren’t on the statin.

There has been a long push to prescribe statins for primary prevention which is total bunk. These are not side effect free drugs. Muscle pain or weakness is common, probably because they inhibit an important pathway that among other things is responsible for production of CoQ10. This enzyme is critical for mitochondrial respiration and as an athlete the last thing you want to be doing is crippling your mitochondria.

As to interpretation of lipid profiles, it’s hard to be prescriptive without a history, but what I would look for is an elevated HDL, low triglycerides, and the LDL is what it is. Total cholesterol is useless. The threshold for hypercholsterolemia has been lowered a few times in recent decades. I would argue the rationale boils down to the fact LDL and TC is a poor predictor of heart disease and so the more you lower the threshold the more at-risk patients you catch (lives saved!). Of course, you also over/unnecessarily-treat greater and greater numbers of patients each time you lower the threshold. If you’re worried about a heart attack, get a coronary artery calcium scan/score done. It’s a very low radiation xray to look for calcified plaques in your heart, a sign you’ve had extensive CVD for quite a while.

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This meta-study does link statin-reduced LDL levels with lower cardiovascular mortality. I didn’t read the whole thing, and my first reaction is that I’d be interested in the rate of cardiovascular incidents rather than mortality.

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If you end up taking statins, be aware that they also block the production of Coenzyme Q10, which is required for optimum mitochondrial function. You can supplement with CoQ10 or the reduced form ubiquinol to offset the effects of statins.

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Probably opening a can of worms, but…a ketogenic diet can have a significant impact on cholesterol and triglyceride levels. I’m one of those genetically high people (~ 240 total cholesterol). After going keto, my HDL more than doubled (from 54 to 112, which my specialist said was the highest she’d ever seen), cut triglycerides in half; risk ratio (which is suppposed to be under 3.5) dropped to 1.6. Food for thought. See what I did there?

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Interesting, I was doing the ketogenic diet and my lipid profile deteriorated.

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(not a doctor disclaimer)
If these are DEXA numbers, then great, otherwise I have to bring up that you likely aren’t in the 18-20% range at that weight unless you are really muscular.

A few no-brainer things that you can do that don’t involve medication if you have a genetic predisposition for higher cholesterol. These will also help you get faster on the bike through a better body composition:

  • Substitute grains for vegetables where it makes sense, especially fibrous ones (i.e. do broccoli instead of rice as a side). Extra fiber (both soluble and un-soluble) is good.
  • Don’t get rid of plant fats. These are almost universally good (as long as you aren’t going crazy). Nuts, avocado, etc.
  • Minimize and reduce sources of added sugar. Easier said than done, but this has been a huge help to me on the body composition side and there are links between sugar and cholesterol. I’ve made it a habit to check food labels to look for extra added sugar
  • Minimize or eliminate fried foods
  • Minimize or eliminate baked sweets (this one is tough for me :upside_down_face:)
  • Minimize or eliminate alcohol consumption
  • Nutrient time ride food to when you are riding. Otherwise, stick to regular meals.

All of the above won’t “specifically” improve your cholesterol profile, but they are holistic things that will make you healthier and should have positive second order effects on cholesterol/blood sugar/body composition, etc which are often very entwined.

For me, my cholesterol improved pretty nicely as I dropped weight, although I was a bit lower than you.

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Losing even 5 to 10 pounds can help lower cholesterol levels. Eat a heart-healthy diet. Concentrate on plant-based foods, including natural products, vegetables, and entire grains. Breaking point immersed fats, found in red meat and full-fat dairy items, and trans fats, found in many prepared foods.

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Sam - how long did you do keto? and did you do any measurements to see if you were actually in ketosis? (blood monitor, pee strip etc)? surprised you had the result you did

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Did most of the above. Needle didn’t move. Your mileage may vary.

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Time to start drinking again then at least :rofl:

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The first lipid test I had was 2 years ago, I was at the tail end of a ~2 year HFLC period. My doc flipped his lid at my numbers, esp the first two:
Tot Chol - 6.83 mmol/L (264 mg/dl) – uber high
LDL - 4.65 (180) – uber high
HDL - 1.82 (70) – fabulous
Chol Non HDL - 5.0 – uber high
Chol/HDL risk ratio - 3.75 – fabulous
Tri - 0.77 (68) – uber fabulous

Just by coincidence, soon after that I started training to race again and switched to a HCLF diet. My lipid test a year later resulted in what my doc called a “Herculean effort” to reduce my chol profile across the board, said most people can never do that. I’ve yet to inform him of my dietary flip. Don’t have those numbers but I do believe they are all in the “normal” range.

Doc just gave the ok for my annual test but I’m going to wait a couple months just to see what happens with my crazy diet this time around.

I’ve read a TON about cholesterol (and the various drugs) in the last couple of years…it seems to me that most of it is uncertain and therefore the medical community resorts to using a shotgun to kill a fly.

The elephant in the room being that the standard lipid test is used because it’s fast and it’s cheap but it gives a wholly incomplete, and possibly incorrect, picture of what’s going on. It’s kind of like taking a wide angle aerial shot of traffic and exclaiming that there’s going to be a lot of accidents because there are a lot of red cars on the road.

Regarding statins and mitochondria…don’t forget that the heart has the most mito by a huge margin…so long term, not sure that reducing mito efficiency is a great solution to “curing” heart disease et al.

Regarding saturated fat being the cause of CVD, I recently read an article which stated that by itself, SF is most likely innocuous in terms of disease; however, when sugar is added to the mix…that’s when things turn ugly. SatFat is the smoking gun, sugar is the trigger was the conclusion. This is something I’ve thought for a few years, also in terms of fuelling – perfectly fine to run on either fat or sugar but not both!

If someone is genetically linked to having high cholesterol, unfortunately, there’s not much you can do about it. No amount of dieting will over-write DNA. That said, it was totally diet which pulled my levels back to Earth…that said, was my “outrageous” cholesterol really a danger (4% Framingham Risk)?

I’d give a rundown of what my current standard diet/supplement regimen is but I wouldn’t want to weird you out! :rofl:

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I was doing a really clean keto diet for about 6 months, I was doing all sorts of blood tests monthly if not more frequently. My LDL values just about doubled so I decided to stop. I was doing piss strips and every morning I was in deep ketosis.

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Cheese - I was really missing cheese.

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you can’t drop a big post like that and not share the diet my dude

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Was it just generic all-inclusive LDL values?

A more advanced test would tell if you were high in small-sized LDL (bad) or large-sized LDL (less bad), and the overall number of the two combined. You might have had high LDL chol but a low number of LDL particles carrying that chol. Like I said above, the standard lipid test is a not worth a lot these days, not with much more detailed tests available.

This is also something terribly…misreported.

As stated above, LDL might be the smoking gun, but sugar is the trigger.

Put another way, without sugar-induced inflammation, LDL flows freely.
Start narrowing and stiffening the arteries…welcome home, fatty b!tches!

Think :hamburger: & :fries:, :cut_of_meat: & :potato:, :spaghetti:, :hotdog:, :pizza:, :cookie:, :cake: …but definitely NOT :doughnut: !!
Basically most refined carb+fat combo meals.

Either live a low-intensity endurance life on a very high fat diet like the Inuit, Greeks, and Doughnutians… or live a high-intensity interval life on a very high carb diet like Nate and durianrider. Start mixing the two and eventually, probably, you’ll get some kinda CVD.

So carb the fxck up and smash out a few rounds of Spanish Needle – cholesterol be damned!
:sweet_potato::sweet_potato::sweet_potato::stuck_out_tongue_closed_eyes:

*(ultra secret food plan may be revealed…sooner or later…)