High Cholesterol despite correct weight, diet, exercise...What to do?

[Amethyst]

Just got the results of my yearly-physical blood tests, accompanied by a brief note from the doctor: "Total cholesterol elevated above 200 at 223 and LDL cholesterol elevated above 100 at 133. Recommend eating a healthy low-fat low LDL cholesterol diet and exercising regularly as tolerated to help with these. Other labs did not show any significant/concerning findings. Thank you."

Thing is, I'm an ovo-lacto-vegetarian, who consumes oatmeal, salads, and olive oil daily. I eat only low-fat dairy (I absolutely cannot stand vegan "dairy" products), barely touch cheese, and limit myself to 3 eggs a week. I eat sweets occasionally. I exercise every day, including three, 3-hour gym workouts per week. There's not an extra pound on me. There are no more lifestyle changes I can make.

For reasons no one seems able to explain, my cholesterol has been borderline high for the past 10 years (I'm 66). This time around, my fasting blood sugar was 82, my triglycerides 100, and my HDL was 69, which is not as high as previous years, but still well in the good range. Blood pressure runs 110/70.

My older siblings struggle with obesity, Type 2 diabetes and heart disease, so there's Family History to consider, but honestly, what else can I do?

Your thoughts are welcome. (I'm aware that diet and nutrition topics can get heated rather quickly - please try to avoid triggering Porky, thanks!).

 

[pacergal]

Some folks just seem to have elevated cholesterol, usually hereditary, and lifestyle may not matter.
Your blood sugar nd blood pressure are in good range to decrease risk of diabetes or hypertension.
Sometimes Statins are the answer, but not everyone will take them.

 

[braumeister]

what else can I do?

Based on what you posted, I don't think you need to do anything.

 

[JoeWras]

My doctor used to be crazy about these kind of numbers and now just says don't worry about it. Keep exercising, he says. Keep the bp low and pulse low. It could also be because my HDL is also high, and my triglycerides low. My blood sugar is also low. Actually, my numbers are very close to yours.

My mom and her family had similar total numbers around 240, but HDL was through the floor, triglycerides through the roof, and blood sugar in the low diabetic range. High BP too. They all had heart disease. I'm hoping I got my Dad's genes on this issue.

It is more than the total number and I think health professionals are waking up to that.

 

[latexman]

Your total cholesterol / HDL ratio = 223/69 = 3.2. According to University of Rochester medical Center that is considered "very good".

Here is the adult range for HDL cholesterol:
Normal: 35 to 65 mg/dL for men, 35 to 80 mg/dL for women

A low HDL cholesterol level is associated with an increased risk for coronary heart disease.

Your total-cholesterol-to-HDL ratio can be figured out by dividing your total cholesterol number by your HDL cholesterol number. Together, these numbers provide more information about your coronary heart disease risk than knowing only 1 of the numbers.

In general:
The higher the ratio, the higher the risk.
Most healthcare providers want the ratio to be below 5:1.
A ratio below 3.5:1 is considered very good.

My Dr. and PA put a lot of faith in this TC/HDL ratio. Mine was >> 5 many years ago, so they prescribed Lipator. It's still > 5 on Lipitor, but TC came way down. Nothing raises my HDL! I've tried everything. So, they have stopped experimenting. Must be working. My Dad and 2 brothers all had by-passes or stents by age 62. I'm 66 and nada!

 

[Sojourner]

For reasons no one seems able to explain, my cholesterol has been borderline high for the past 10 years (I'm 66). This time around, my fasting blood sugar was 82, my triglycerides 100, and my HDL was 69, which is not as high as previous years, but still well in the good range. Blood pressure runs 110/70.

You might want to consider a cardiac calcium scan. They are cheap (~ $100), quick, and painless. I also have high cholesterol (225) along with slightly higher-than-normal triglycerides (155), so my doctor suggested a calcium scan to get a better picture of my cardiac artery health. Turned out my score was zero dance, which led to him not prescribing statins for me. He told me to exercise more, lose some weight, and avoid sweets and fatty foods.

My older siblings struggle with obesity, Type 2 diabetes and heart disease, so there's Family History to consider, but honestly, what else can I do?

Have you had your A1C tested? Even very thin people who exercise a lot and eat pretty healthily can have borderline-high A1C. With your family history, might be worth looking into just as a precaution.

 

[Golden Mean]

You might take a look at any of the videos on Youtube from Low Carb Down Under regarding this subject. Your body needs cholesterol to work and trying to artificially reduce it to fit an arbitrary number (that keeps being arbitrarily lowered) is probably unhealthy. The idea that dietary cholesterol is an issue (e.g. eggs) is about 20 years out of date. Even the most zealous anti-fat groups have dropped dietary cholesterol as a 'nutrient of concern'.

Also, low fat dairy may be the least healthy dairy you can pick. All the healthy fats (and fat soluble vitamins) we need are removed and it becomes a sugar drink (with proteins many adults don't tolerate well).

 

[Sarah S]

Unfortunately as noted genetics play a part. There is a calculation for 10 year cardiovascular risk. From what you have posted your risk is low so probably just keep doing what you are doing now

 

[badatmath]

My doctor told me some time ago being hypothyroid made my cholesterol a little high.

I assume they would have checked you for that in routine blood tests, but IDK for sure since I have had the issue since childhood and it is always checked for that reason.

 

[athena53]

My numbers have been around that level for ages. Like you, I'm at a healthy weight, low BP, exercise regularly (daily in my case) and I'm practically vegetarian. I took Prevastatin about 10 years ago and ended up with tendonitis so bad it hurt to raise a spoon to my mouth. Symptoms faded away after I threw them out.

I highly recommend the podcasts of Dr. Peter Attia ("The Drive") on the subject of cholesterol although he gets WAY into the weeds of biochemistry. I try to look at the whole picture: no history of heart disease at age 70 (mitral valve prolapse being monitored by a cardiologist), calcium score of 1, low CRP score (measures extent of inflammation), Apo-B not bad, resting heart rate 53, took one treadmill stress test and I must have done OK since it was never repeated. My cardiologist is willing to write a prescription for a statin but not insistent, probably because he looks at the whole picture, too.

It's a controversial topic but I come down on the side of, "If it ain't broke don't fix it".

 

[Amethyst]

Thanks. I can probably get those tests on my own, but I'll send a note to my Dr. to see if he will authorize such tests (so insurance will pay).

You might want to consider a cardiac calcium scan. They are cheap (~ $100), quick, and painless. I also have high cholesterol (225) along with slightly higher-than-normal triglycerides (155), so my doctor suggested a calcium scan to get a better picture of my cardiac artery health. Turned out my score was zero dance, which led to him not prescribing statins for me. He told me to exercise more, lose some weight, and avoid sweets and fatty foods.



Have you had your A1C tested? Even very thin people who exercise a lot and eat pretty healthily can have borderline-high A1C. With your family history, might be worth looking into just as a precaution.

 

[Amethyst]

Thanks. My TSH levels are normal.

My doctor told me some time ago being hypothyroid made my cholesterol a little high.

I assume they would have checked you for that in routine blood tests, but IDK for sure since I have had the issue since childhood and it is always checked for that reason.

 

[Amethyst]

Thanks - I've been on the least-processed-possible food train for a long time.
I spend the time to prepare foods from the rawest materials possible (vegetables, whole grains, spices rather than salt for seasoning). Have been getting into organic recently - despite the high cost.

https://nutritionstudies.org/whole-food-plant-based-diet-guide/

 

[Amethyst]

Thanks - As I've aged, I've tried not to get caught up in "All my numbers must be better than perfect!" Good enough, is good enough.

And I also hate taking RX's, because I tend to get side effects from everything.

My numbers have been around that level for ages. Like you, I'm at a healthy weight, low BP, exercise regularly (daily in my case) and I'm practically vegetarian. I took Prevastatin about 10 years ago and ended up with tendonitis so bad it hurt to raise a spoon to my mouth. Symptoms faded away after I threw them out.

I highly recommend the podcasts of Dr. Peter Attia ("The Drive") on the subject of cholesterol although he gets WAY into the weeds of biochemistry. I try to look at the whole picture: no history of heart disease at age 70 (mitral valve prolapse being monitored by a cardiologist), calcium score of 1, low CRP score (measures extent of inflammation), Apo-B not bad, resting heart rate 53, took one treadmill stress test and I must have done OK since it was never repeated. My cardiologist is willing to write a prescription for a statin but not insistent, probably because he looks at the whole picture, too.

It's a controversial topic but I come down on the side of, "If it ain't broke don't fix it".

 

[homestead]

I have taken a couple brazil nuts daily for years for the selenium. My cholesterol runs about 143. I suspect the selenium is helpful in keeping my cholesterol lower.

 

[brett]

My spouse will find out today when she sees her physician.

She has high blood pressure. Now her cholesterol count is high enough for the physician to be concerned.

Same...right weight, eats a careful diet, we hike every day at home and walk constantly on vacation.

She is very frustrated and expects a prescription

Both are hereditary. I am the exact opposite.

 

[street]

Sounds like you are doing all you can to have healthy numbers. I believe just like everyone else has said, it is heredity.

The other thing I feel you could do is to get on medication to help.

I'm like you not an ounce overweight and am very active all the time with working at ranch, home and exercising. I was a border line cholesterol victim at times because of heredity. Most years my blood work was perfect and then some elevated a little. I'm also the same age you are.

I was started on them last January and what a difference in the numbers.

Good Luck and I hope you can find the numbers you are after.

 

[Chuckanut]

You might read Dr. Lustig’s book - Metabolical. It’s another look at what we eat and how medical testing is evaluated. It opened my eyes to some things I had never considered such as there is no medicine to cure Metabolic disorders, just control it. Curing Metabolic disorders requires improving the diet. IOW, proper food is the medicine for this problem. Dr. Lusting explains it better than I can.

FWIW, I take a small dose of a statin (10mg) about 4-5 days a week. Sometimes I forget. Most of the cholesterol reduction occurs with the smallest dose, then another 6% reduction with each doubling of the previous dose. IOW, the minimum dose gets the most bank for the buck, then the law of diminishing returns kicks in big time.

+1 on vegan cheese and such other Frankenstein foods that try to imitate meat. I’ve had great vegetarian meals and none of them pretended to be meat. Why is it I have never seen a meat eater invent a clever way to turn a good beefsteak into a fake turnip?

 

[JBTX]

Just got the results of my yearly-physical blood tests, accompanied by a brief note from the doctor: "Total cholesterol elevated above 200 at 223 and LDL cholesterol elevated above 100 at 133. Recommend eating a healthy low-fat low LDL cholesterol diet and exercising regularly as tolerated to help with these. Other labs did not show any significant/concerning findings. Thank you."

Thing is, I'm an ovo-lacto-vegetarian, who consumes oatmeal, salads, and olive oil daily. I eat only low-fat dairy (I absolutely cannot stand vegan "dairy" products), barely touch cheese, and limit myself to 3 eggs a week. I eat sweets occasionally. I exercise every day, including three, 3-hour gym workouts per week. There's not an extra pound on me. There are no more lifestyle changes I can make.

For reasons no one seems able to explain, my cholesterol has been borderline high for the past 10 years (I'm 66). This time around, my fasting blood sugar was 82, my triglycerides 100, and my HDL was 69, which is not as high as previous years, but still well in the good range. Blood pressure runs 110/70.

My older siblings struggle with obesity, Type 2 diabetes and heart disease, so there's Family History to consider, but honestly, what else can I do?

Your thoughts are welcome. (I'm aware that diet and nutrition topics can get heated rather quickly - please try to avoid triggering Porky, thanks!).

You are probably ok. If I were in your situation I’d get a coronary artery calcium test, they are between $100-$200, are quick and painless, and it will give you an indication of calcium buildup, which is highly correlated to heart risk. I got one a year ago and it was higher than expected and based upon that made some significant changes in my life. If it is very low you likely have nothing to worry about. If it is high then talk to your doctor, he may suggest a statin.

You could eat some foods supplemented with plant sterols or plant stanols (see Benocal). They do work and lower LDL 10-15%. I quit taking them though as there is some mixed data that in spite of cholesterol reduction, they may themselves cause artery plaque buildup.

I went from an LDL 180 to 120 in 6 weeks using plant stanols, losing 10 lbs, ,eating healthier with plenty of soluble fiber. Added low dose statin and lost 15 more pounds and LDL went to 70 6 month later.


You could take an APOb test which has been shown to be more accurate that LDL as a risk indicator.

Things with soluable fiber, like oatbran, Metamucil May move the needle a little bit.

 

[Teacher Terry]

My blood work is done yearly and my cholesterol has widely varied from 176 to 240. Most cholesterol studies have been done on men and are not predictive of heart disease in women. I would never take a statin. I have known women to die of old age with zero heart problems that had genetic cholesterol around 300. I am not overweight and exercise daily. I am not as careful with my diet as you are.

I do have genetic HBP which runs on my mom’s side of the family. I also have asthma so need medication for both of them. So many older people are on too many medications which end up fighting with each other. My goal is to only take what is necessary.

 

[jollystomper]

I do not think you need to be concerned, in the context of your other numbers.

They are similar to mine, but in my case it seems to be due more to hereditary (according to one brother who is a doctor and has looked into this for our family). TC/HDL ratios run between 2.5 and 3 among my siblings and I.

I am on a statin and HBP (mine is "borderline" but due to it running in the family my doctor recommended), but heart disease/weight issues do not run in our family, and closer examination of my arteries via congenital heart surgery/MRIs/nuclear stress tests have shown everything to be clear.

 

[Mark1]

Just got the results of my yearly-physical blood tests, accompanied by a brief note from the doctor: "Total cholesterol elevated above 200 at 223 and LDL cholesterol elevated above 100 at 133. Recommend eating a healthy low-fat low LDL cholesterol diet and exercising regularly as tolerated to help with these. Other labs did not show any significant/concerning findings. Thank you."

This looks like a CYA, generic form letter response from the doctor, so I won't worry about it. As other have stated your Total/HDL ratio looks fine. I would be more worried if your doctor gave you this response to your face, when you already do so much of the recommendations. If so, it might be time to look for a new doctor that actually know their patients.

 

[eytonxav]

You have great numbers in my opinion and do not see any reason to be concerned. If you want to try something to lower the LDL levels, I'd give phytosterols a shot. I take the Vitamin Shoppe brand, Super Phytosterols and it has improved my LDL for the better.
https://www.vitaminshoppe.com/p/super-phytosterols-900-mg-90-tablets/vs-2660

 

[Ronstar]

I would do as your dr recommends (which you are already doing) and let the numbers fall where they may.

 

[pdxgal]

My advice is not to worry about it. My diet and health stats are very similar to yours, and have been that way for most of my adult life (I'm a 61 yo woman). AFAIK, many of the studies linking high cholesterol to heart disease were done on men, so not directly applicable for us women (which I believe you are IIRC from other posts). So there's that. Also, American physicians too often don't take a holistic view of health and look at lab results in isolation. As an example, there are two types of LDL: big vs little particles. Apparently for LDL, size matters - it's the little ones that build up in arteries and are bad.

Here's an alternative view of your situation and mine, from Healthline:

When you have low triglyceride levels but high LDL levels, it could indicate that you have a diet filled with healthy fats.

Healthy fats will not only cause an increase in good cholesterol (HDL) but can also change the type of the LDL particles in the blood. Therefore, those high LDL levels may not actually be a bad thing.

Instead, it is more likely that they are LDL particles that have become larger and less dense from the intake of healthy fat. Low triglycerides and high HDL levels in the blood will generally support this idea.

https://www.healthline.com/health/low-triglycerides