My Cholesterol Journey (part 1)

My cholesterol levels aren’t exactly what you’d call ‘ideal’. At least, not according to those pesky ‘standards’ that everyone seems to follow. Even when I was younger, my cholesterol was always a little high. Now that I'm in my 60s, my total cholesterol number was flirting with 200. I managed to get it down to around 180 after I switched my breakfast to oatmeal, but then it crept back up to 201 last year, and just recently spiked up to 240. My PCP wasn’t worried about the 201, and didn’t even hint at statins, but the 240? Well, that’s a potential problem.

So, I’m scheduled for a retest in a couple of months, and if it’s not lower, we might be having a serious conversation about drugs. This seems to be a family tradition—my mother had high cholesterol since they started measuring it, and my super fit brother (no almost about it), is already on a statin.

Statins can be handy little drugs, but they come with side effects that I’d really like to avoid. So, what’s a cholesterol-challenged person to do? Should I consider them if my PCP suggests it? What cholesterol levels are concerning? Should I be worried? Let’s dive into this cholesterol conundrum.

Cholesterol Guidelines: A Game of Math

According to the American Heart Association (AHA), they use a calculated risk score for cardiovascular disease (CVD) to figure out if you should consider statin therapy. It’s like a game of roulette, but instead of a ball, you’re betting on your cholesterol levels. The initiation of therapy isn’t based on a single measurement; it’s more like a group project where they consider your total cholesterol, LDL levels, age, gender, BMI, eGFR, and whether you have diabetes or other conditions. You can calculate your risk online here.

According to the AHA, medication initiation is only recommended in certain situations, and they only cite an LDL level over 190 as a reason to consider therapy based solely on numbers. Lucky for me, I don’t fit into those circumstances. Yay! My 10-year risk of CVD is 4.4%, which is well below the 7.5% threshold that raises eyebrows. So, I guess I’m not getting kicked out of the cholesterol club just yet! Note that this is because I'm a woman - I accidentally ran this same calculation and forgot to check female. If I was a man it would be 6.7%.

What is the ideal level?

This got me wondering—what’s the ideal cholesterol level? Can it be too low? Is there a range where it doesn’t really matter? Spoiler alert: I couldn’t find any hard and fast answers. Most research focuses on LDL levels, and there seems to be a consensus that HDL (the ‘good’ cholesterol) should be >50, with ‘higher is better’. My HDL is 68, so I’m doing alright there. But my LDL is supposed to be <100 and mine is 153.

What to do

My PCP told me to wait a couple of months after the holidays and then retest. I’m writing this on Ash Wednesday, at the beginning of Lent, when I’ve already committed to giving up cakes and cookies. I may dive into this at a later date, but my initial investigation suggests that exercise has a modest effect on LDL. So, I’m focusing on diet changes that may help.

I went looking for recommendations from the usual sources and found what I consider to be the standard diet recommendations—lots of fruits and vegetables, lean proteins, whole grains, etc., most of which I’m already doing. I wanted to get more specific to LDL and understand what had been studied specifically for reducing LDL. I found lots, but this Swedish paper by Schoeneck and Iggman provided a fantastic review summary. They have this wonderful chart showing which foods have evidence for either lowering or raising LDL and how strong that evidence is. Foods below the line lower LDL, above the line raise it. On the line, no difference. The size of the circles is related to how strong the evidence is for the effect. So, for example, avocado looks like it has a large effect, but the evidence is not strong.

Based on this I have already made some changes and are continuing to modify my diet.  We’ll see what happens!

What I’m Doing

What I Already Was Doing

• Old-fashioned oatmeal for breakfast most days. Trying to do more steel-cut oats.

• Green tea in the afternoon. Because I’m fancy like that.

Changes I Made Recently

• Switched from full-fat dairy to low-fat or fat-free. Yogurt is now 0%. Milk is on a step-down plan from 2%

• Using Smart Balance instead of butter. Because I’m trying to be smart, not just buttery.

• Changed to filtered coffee (got little filters for my reusable K-cups).

• No cookies/cakes/etc. during Lent. Hope I can stick with this after

I'm Tryin’

• Using olive oil instead of butter where possible. A Mediterranean diet is calling my name!

• Adding beans and pulses. Discovered already cooked lentils to toss into my green salads. Making my three bean salad recipe.

• Snacking on nuts more. I like nuts okay, but I just don’t think of them for some reason.

• Metamucil – bought some, tried it, didn’t like it. It torned to a gelatinous goo. Need to figure out how to incorporate this. There is evidence that it helps.

  
  

So there you have it! My cholesterol saga continues, and I’ll keep you updated.