Study Proves Exercise Staves Off Bad Cholesterol

I’ve been in an exercise black hole since January 29th – the day I hurt my elbow shoveling. Since I had tennis elbow surgery 10 years ago, I knew this time to immediately stop playing tennis and quit spin to let my elbow heal. Suddenly it was 4 months later and I’ve gained weight and am out of the regular exercise habit.

YES, I could have done some other exercise. YES, I have both a treadmill and an elliptical in my home. NO, I didn’t use them and instead wallowed in my sadness that I’d reinjured my elbow.

And YES, I regret my sloth as I gained 5 pounds in four short months.

My elbow is still not 100% but now I’m on the slow path to regaining cardio fitness – and hopefully losing the weight that irks me daily as my jeans don’t fit.

And while exercise is harder than ever for me (getting old really bites: various body parts scream in protest when pushed), the good news is that a recent study of 11,000+ men proves that exercise may delay age-related high cholesterol levels.

An article entitled,The Effect of Cardiorespiratory Fitness on Age-Related Lipids and Lipoproteins was published online in the Journal of the American College of Cardiology, on May 11, 2015. While I can’t read the actual article as it costs $35 to purchase (!) I’m writing based on several reputable sources who reported on this study.

Researchers used data from the Aerobics Center Longitudinal Study in Dallas, Texas, collected from more than 11,000 men between 1970 and 2006 to assess total cholesterol, LDL (bad) cholesterol, HDL (good) cholesterol and triglycerides.

As Lisa Rapaport of Reuters reported in her article, Men Who Exercise May Delay Age-Related High Cholesterol, in the study, “researchers followed thousands of men over several decades, periodically drawing blood to test their cholesterol and then making them run on treadmills to measure their cardiorespiratory fitness. Men who could run longer and faster – signs that their bodies more easily deliver oxygen to muscles – also had lower cholesterol.”

“The better men did on fitness tests, the more likely they were to have lower total cholesterol, as well as lower levels of what’s known as low-density lipoprotein (LDL), the bad kind of cholesterol that builds up in blood vessels and can lead to atherosclerosis, blood clots and heart attacks.

Fitter men also had higher levels of so-called high-density lipoprotein (HDL), the good cholesterol that helps purge the bloodstream of LDL.

Men with higher cardiorespiratory fitness levels had better cholesterol profiles than less fit men from their early 20s until at least their early 60s, though the difference diminished with older age.

At the same time, men with lower fitness levels reached abnormal cholesterol levels before age 40.”

Said differently, unfit men were at risk of developing high cholesterol in their early 30s, but those with better fitness levels did not see it rise until their mid-40s, around 15 years later.

Dr. Gregg Fonarow, professor of cardiology at the University of California, Los Angeles, was widely quoted about this article online: “Exercise is a vital component of achieving lifelong cardiovascular health. Regular physical activity and maintaining physical fitness has been shown to be associated with a lower risk of [heart attack], stroke, and premature cardiovascular death.”

How much exercise is needed? According to study co-author Dr. Xuemei Sui, an Assistant professor at the Arnold School of Public Health at the University of South Carolina, to achieve the fitness levels necessary to ward off age-related high cholesterol, men should get 150 minutes a week of moderate activity (gardening, dancing, brisk walking) or 75 minutes of vigorous activity (jogging, running, swimming, cycling).

That’s 30 minutes of aerobic activity (a brisk walk!) five days a week, or 3-4 runs a week (or for me: tennis or spin 2-3 times a week).

Of course this study was done just with men. Actually, healthy white men. Of course that is incredibly frustrating. But I am going to go out on a limb and assume the same healthy benefits may confer on men and women in general.

And hope that getting back to the regular/daily exercise that will make my jeans fit again will also keep bad cholesterol at bay.

 

 

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Cholesterol Results 2014

So I finally bucked up and got my cholesterol tested in November and the results were surprising.  First of all, my cholesterol – after a year of reasonably careful eating and a lot more exercise, but no Metamucil or Fish Oil pills – actually moved in the right direction.

Details in a second.

Not only that, my new cardiologist (again, more in a sec on why I needed to finally see a cardiologist) actually called my cholesterol results “enviable.”

Enviable, people.

This shocked me. Especially because I gave up on the fish oil pills which apparently now, in a total turnaround from past belief, don’t help much with cholesterol. (It’s frustratingly difficult to keep up with what’s recommended –  and what is no long considered effective – for managing cholesterol without statins.)

That said, in the face of a genetic predisposition toward high cholesterol, I’ve managed through diet and exercise to avoid cholesterol medication.  Though truth be told, that’s more likely due to the American Heart Association’s 2013 revised Guidelines For Managing Blood Cholesterol than anything I’ve done… if the Guidelines hadn’t been revised, I’d probably still be having the statin conversation with my doctor.

In any case, here are my exciting (ha ha) cholesterol results.

My overall cholesterol is UP and now measures 246 – which used to be considered high but is apparently now not so big a deal.  Not a big deal, I guess, because my LDL (bad) cholesterol keeps falling (“goal” is less than 130 and mine is now 123) and my HDL (good) cholesterol keeps rising (“goal” is higher than 46 and mine shot up to 95).

NOTE: I put “goal” in quotes because these goals are no longer really in line with the new Guidelines; I find it fascinating that they are still reported as “goal” when the only goal according to the new guidelines is LDL (bad) cholesterol over 190 along with other heart disease risk factors that have nothing to do with cholesterol results.  Bizarre that this is still ‘outdated’ a year later.  Or maybe not bizarre, just sad.

In any case, I’m excited about the results.  Here’s a chart for those who prefer graphs.  If that’s not you, skip to cardiologist discussion 2 paragraphs below!

KLS Chol Trend Thru 2014

You’ll see the red line of total cholesterol is still high and rising – but no one seems worried about that, since the green line of LDL (bad) cholesterol is falling along with the purple triglyceride line … and because the blue line of HDL (good) cholesterol is rising.

Things certainly do change – I’m so glad I never started on a statin back in 2010-2011 when my numbers looked like a statin was in order.

Now, on to cardiologist.  My cholesterol results were surprising – and nicely so. But at same blood test I found I am positive for a blood clotting disorder, so that was a major bummer.  It’s not treated – and not dangerous unless you take hormones (which of course I was) so that had to stop immediately.

And then it turns out my blood pressure has risen quite dramatically.

Likely the stress of this past year – along with wondering and worrying about the blood clotting disorder.  Hence my doctor-referred trip to the cardiologist.

So my new cardiologist and primary care doctor are sorting out how to deal with my (hopefully short-lived) blood pressure issue … and on the plus side, I really liked the new cardiologist.  And when we discussed cardiac risk and my cholesterol trends and family history, he also thought that getting a handle on what my cardiac risk really looks like is a good idea.  So I had two more blood tests – and YAY – these are the very tests I’ve written about thinking made sense for me in Cholesterol Tests Your Doctor Hasn’t Told You About.  Finally!

So I had blood tests for both C Reactive Protein (CRP is a measure of inflammation in the body and high levels have been associated with heart disease) and also a full lipid analysis that will measure LDL density, ApoB and more.  I am really relieved to finally be getting a handle on cardiac risk.  Lastly, am debating about getting a Coronary Calcium test done – it’s a CT test so there’s radiation involved (and Aetna denied coverage) so I’ll likely wait until the blood test results come back to decide.

So on plus side, my cholesterol tests are now ‘enviable’ but am waiting for the blood test results to come back and really help hone in on cardiac disease risk. Oh, and trying to figure out how to get my blood pressure back to normal.

So I’ll end 2014 with a question for you: how’s your cholesterol? And, um, blood pressure? If you don’t know, please resolve in 2015 to have them checked.

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Learning About Cholesterol

It’s been rather a long while since I wrote about the importance of finding reputable online resources for learning about cholesterol. You can permanently locate links to educational resources on my Resources/Info Links page, but I thought it might be helpful to discuss in a post.

Why?

Well, quite frankly it’s because when discussing high cholesterol and heart disease risk, many doctors – who speak daily, probably, about cholesterol – rush through the conversation and use unfamiliar terms. On the receiving end it can feel like a tornado rather than a give and take discussion of personal cholesterol results and the resulting medical goals.

Plus, you’re going to google cholesterol anyway, you know you are.

Which is good, actually, because the more you know about cholesterol and heart disease risk – and treatment alternatives — the more committed you are likely to be to your cholesterol management program. Well, maybe. (My commitment waxes and wanes.) At the very least, researching online will enable you to create a list of questions to ask your doctor at a follow up appointment.

And researching should help you question whether prescription medication is absolutely necessary for your personal cholesterol management plan. Which is a vital step many seem to skip.

Truth be told, cholesterol-lowering statin medication is absolutely justified for many, many people – and these meds have undoubtedly saved many lives. But if high cholesterol is your only risk factor, you should question the validity of statin meds for you individual case. Have a discussion about the pros and cons with your doctor. And to do that well, you need knowledge.

But you don’t want to search just anywhere on the web. Some sites – such as WedMD — are largely funded by big pharmaceutical companies so you’ll want to know their slant. To help ensure you are gleaning information from reputable, unbiased sites, here are a few to check out.

An excellent source is the National Cholesterol Education Program (NCEP) which I recently wrote about in my post, September is National Cholesterol Education Month. This site has a great deal of useful information, though it’s layout makes it difficult to navigate. See my post for specific links to the useful sections of this site – including an online calculator for heart disease risk.

For an excellent overview about cholesterol, a visit to the American Heart Association – Cholesterol Overview site is a great place to start. This site explains that cholesterol itself is not ‘bad’ and that it is created both by our bodies and from the foods we eat. Scrolling through this article you’ll find an explanation of ‘good’ and ‘bad’ cholesterol, and there’s even an animation if you really want to get a visual of what cholesterol is and how it works in your body.

The Mayo Clinic is one of my favorite sites for unbiased, well-explained information about cholesterol and heart disease risk. (Go ahead. Color me geeky.) It is vital to truly understand your personal heart disease risk; the Mayo Clinic’s High Cholesterol Risk Factors page explains that there are seven conditions which, when combined with high cholesterol, elevate heart disease risk.

Test results are a big factor in risk assessment, and it’s pretty likely that your doctor zoomed through your personal lipid panel test results and what they mean. To learn more about why the goal for ‘total cholesterol’ is at or under 200 mg/dL, what triglycerides are, and what those HDL and LDL numbers really mean, visit the Mayo Clinic’s incredibly useful High Cholesterol Tests and Diagnosis page. This page is an excellent reference that explains the targets for each key cholesterol measure – and relates them to heart disease risk level. In my humble opinion, this page is one of the most useful online resources available.

Finally, if you want to avoid statin medication by lowering cholesterol through diet and lifestyle, you’ll want a good nutritional resource. For that, the Cleveland Clinic’s Nutrition-Cholesterol Guidelines is a terrific resource that explains what’s good and bad about things like the different kinds of fats, dietary cholesterol, protein, carbohydrates, and plant sterols. Even better, it gives a daily target for each. Best of all (major geek alert), there’s a handy chart that summarizes the key info all in one place. Make sure you scroll to the bottom of the page to see this useful chart.

And OK, I lied a minute ago. In my humble opinion, the Cleveland Clinic’s nutrition-cholesterol guidelines page is one of the most useful online resources available.

Let’s make it a tie. I vote that the Mayo Clinic’s High Cholesterol Tests and Diagnosis page wins for explaining test results and targets, and the Cleveland Clinic’s Nutrition-Cholesterol Guidelines page wins for showing how to combat high cholesterol, nutrition-wise.

Beyond these there are, of course, many other great online sources for information about cholesterol and heart disease risk. And your doctor is potentially the best resource of all. That said, the more you know, the better questions you can ask your doctor — and that will go a long way to ensure the program you and your doctor devise is the best possible course for you.

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Cholesterol Tests Your Doctor Hasn’t Told You About

A standard cholesterol lipid panel  provides four measures: Total Cholesterol, LDL Cholesterol, HDL Cholesterol and Triglycerides.  But did you know that there are two other blood tests — and one ratio that’s easy to calculate — that can better predict your risk of heart disease?  Which means that even with high cholesterol, you might not need a statin medication if these tests show low cardiac disease risk.

Or you might think you don’t need a statin … and in fact do.

And yet, your doctor probably has not told you about these tests.  So let me.

Apolipoprotein B – or as it’s commonly referred to, ApoB, is a simple blood test that measures the number and size of LDL (bad) cholesterol. Why this test is useful is well explained by Johns Hopkins Health Alerts:

“The problem with using LDL cholesterol levels to determine heart attack risk is that the test measures only the amount of cholesterol in the LDL cholesterol particles, not the number or size of these particles. Apo B measurements, on the other hand, provide information on the number of LDL cholesterol particles.

For example, people with a higher apo B value than LDL cholesterol value tend to have smaller, denser LDL cholesterol particles. Studies have shown that small, dense LDL cholesterol particles are more strongly associated with heart attack risk than large, “fluffy” LDL cholesterol particles.”

So if you have high LDL cholesterol (goal is under 130), you might want to find out if you have the ‘fluffy’ kind of LDL (pattern A), or the more dangerous, small, dense type of LDL (pattern B). Indeed, the Johns Hopkins Health Alert goes on to explain, “Research published in The Lancet reviewed five studies of LDL cholesterol and ApoB in nearly 200,000 people. The researchers concluded that high levels of ApoB were more strongly linked with future heart attack risk than LDL cholesterol levels.”  Compelling, no?

Low Density Particle Number, or LDL-P, is a similar measure – and again, one that’s been shown to be a more accurate predictor of heart disease than the typical cholesterol measurements.  LDL-P measures the number of LDL particles in the blood, whereas LDL is just the total LDL cholesterol.

As explained in The Difference Between LDL-C and LDL-P on the Primal Docs website, two people with the same LDL numbers can have vastly different heart disease risk because one has low LDL-P (fewer LDL particles of the type A, big, fluffy kind) while the other has high LDL-P, or a lot of LDL particles, of the small, dense, type B kind:

“…one person (person A) may have large cholesterol rich LDL particles, while another (person B) may have smaller cholesterol depleted particles. These two persons may have the same LDL-C concentration. However, person B will have higher LDL particle number (LDL-P). Despite similar levels of LDL-C, person B is at higher risk four future cardiovascular events. Furthermore, person B will have more small LDL-particles.”

The doctor who wrote this explanation of LDL-C vs. LDL-P goes on to explain that both LDL-P and ApoB are stronger predictors of heart disease risk than typical cholesterol measures:

“Some studies have suggested that the size of LDL-particles may be of importance. People whose LDL particles are predominantly small and dense, have a threefold greater risk of coronary heart disease.

ApoB and LDL-P both reflect the number of atherogenic lipoprotein particles. Measurements of ApoB and LDL-P are better predictors of cardiovascular disease risk than LDL-C. Furthermore, ApoB and LDL-P may predict residual risk among individuals who have had their LDL-C levels lowered by statin therapy.”

Non-HDL Cholesterol is a third important measure — and you don’t even need to take a blood test. Non-HDL-C is simply your Total Cholesterol minus HDL Cholesterol.  The tricky part is figuring out goal: if your LDL cholesterol is “at goal” you can roughly estimate your non-HDL-C goal by simply adding 30 to your LDL goal (these goals are usually on the cholesterol report – they are also online or you can ask your doctor.) And if it’s not at goal, discuss this ratio with your doctor.  I wrote about non-HDL-C and how to calculate it in this blog post, Do You Know Your Non-HDL Cholesterol?

While researching these in-depth cholesterol tests, I came across this compelling medical case study. It socked me in the gut, as this woman’s lipid panel cholesterol results were similar to mine, and yet it turns out from the additional LDL-P and ApoB testing that she was at high risk for cardiac disease. And needed statins.

Gulp.

So how do you get these tests?

I asked my internist about them months ago, and she said I didn’t need them — that my cholesterol numbers are fine. But now that I’ve read this case study I feel I would love more information.  I’ll have to ask her again about additional testing – especially now that I have more info.

And just so you know, you don’t have to travel to the Cleveland Clinic or the Mayo Clinic or Berkeley, California to get these tests. The Johns Hopkins Health Report explains,

“One widely used test, called the NMR LipoProfile, analyzes the size of lipoprotein particles in the blood by measuring their magnetic properties. Several others, including the LipoPrint and the Berkeley (from Berkeley HeartLab) use electrical fields to distinguish the size and other attributes of lipoprotein particles. Still another, known as the VAP (for Vertical Auto Profile) test, separates lipoprotein particles using a highspeed centrifuge.”

Even though my cholesterol is at goal, I’ve got to put in a call to my internist to ask about getting both the LDL-P and ApoB testing done. Will keep you posted.

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Grapefruit Pros and Cons

In all the ‘bazillion ways to lower cholesterol’ lists I’ve read, not once did I see grapefruit listed. Well, it may have been listed (I don’t like grapefruit so it’s entirely possible likely I, um, skipped by it) but grapefruit is certainly not prominent on any list of foods that can help lower cholesterol.

And yet, apparently, it should be.

At least according to a 2006 (small) Israeli study posted online in the Journal of Agricultural and Food Chemistry. While the study is a few years old and included just  57 people, these were a pretty motivated group IMHO: they’d been unsuccessful lowering cholesterol with Rx statins, had suffered through heart surgery and still needed to reduce their cholesterol. My gut tells me they were a pretty compliant group.

WebMd’s Grapefruit May Improve Cholesterol article explains this study and its results:

“The researchers split the patients into three groups. For 30 days, all groups ate a low-calorie, low-fat diet. One group added a daily red grapefruit. Another group got a white grapefruit every day. For comparison, the third group didn’t eat any grapefruit during the study.

The red grapefruit group improved their cholesterol most, followed by the white grapefruit group. They ended up with notably lower total cholesterol and LDL (“bad” cholesterol) than the comparison group.

The red grapefruit group also improved their triglycerides (blood fats). Triglycerides didn’t change much for the other two groups.”

Red grapefruit alone seems to have lowered LDL (bad) cholesterol and tryigycerides!

Why is this barely out there?  Why, if grapefruit – grapefruit, people – can help lower cholesterol, why is this not widely touted?

It must be because grapefruit can cause serious medical issues IF it’s consumed along with one of many, many medications (the list – see quote below – is startlingly long and broad).

As explained in my recent Answers.com article, ‘Grapefruit Danger‘, the juice of grapefruit changes the rate certain drugs are absorbed into the bloodstream. With several cholesterol-lowering drugs, grapefruit juice can boost the level of statin to potentially dangerous levels.

However, it’s not just statins that interact with grapefruit.

Shela Gorinstein, PhD, one of the authors of the above Israeli study says, “…remember to check with your doctor first if you take any medicine, even if it’s not a cholesterol-lowering drug. Other types of medications that can interact with grapefruit juice include drugs for blood pressure, heart rhythm, depression, anxiety, HIV, immunosuppression, allergies, impotence, and seizures.”

Because grapefruit juice interacts with such a broad variety of prescription medication, my guess is that it’s been intentionally omitted from the lists of cholesterol-lowering foods. Which is understandable, I guess – but a huge shame.  Because for those of us not on any Rx meds, maybe grapefruit can keep us off statins!

As I don’t take any prescription meds other than Nexium (which is not on the many-drugs-grapefruit-interacts-with-list), I think I’m going to try me some red grapefruit.

Even though I despise its puckery taste.

Because if I can lower my triglycerides with grapefruit, I can eliminate my nightly wine misgivings. And puckery in the morning is a small price to pay for guilt-free wine in the evening.

I wonder if I can put my Metamucil in red grapefruit juice?  I’ll have to get back to you on that.

 

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