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A Handle on your Health: Cholesterol & the magic number

Tuesday, March 5, 2019

Anyone been to their doctor lately for a cholesterol check? You were likely either told “Good job your cholesterol is great” or “We need to work on getting your cholesterol down.” Don’t beat yourself up if your cholesterol came back high and you were told you needed to work on it. It may not be all your fault.

Cholesterol research in the 1940s began to show a correlation between high fat diets and elevated levels of cholesterol. That makes sense right? You eat more fat therefore you have more fat in your system. The most famous study from then was the Framingham study, which found a link to cardiovascular disease in people with higher levels of cholesterol. By the 1960s the belief in a low fat diet was taking hold.  By the 1980s a low fat diet was the standard and it was applied to everyone everywhere by virtually all health professionals. There were skeptics at the time but that didn’t stop the momentum of the low fat diet.

When I started practicing medicine in the late 1990s, it was standard practice to advise patients to eat a low fat diet to keep their cholesterol low. Exercise, weight-loss, a diet low in fat and if all that didn’t work, a pill to lower your cholesterol. Now new studies are questioning the validity of long held beliefs in medicine regarding cholesterol and our health. Maybe it’s not all cholesterol’s fault for our heart attacks and strokes after all.  

There are studies coming out now indicating bad cholesterol, LDL, which has been blamed for cardiovascular disease for years is actually not to blame. LDL cholesterol may even be beneficial. It’s not that the early studies were flawed but the interpretations of those studies were poorly applied to the entire population. The initial recommendations by the American Heart Association in the 1960s regarding cardiac health did include a low fat diet but it was intended toward high risk patients. But here in America we like painting with broad strokes so a low fat diet must be good for everyone. The AMA and NIH as well as other groups all endorsed the low fat diet for all starting in the 1980s. You can also blame insurance companies for publishing ideal weight charts which then turned into BMI (body mass index) charts and declaring that everyone should fit neatly into their defined box of health.  The food industry also found it quite lucrative to be in the “low fat” diet business. Lastly big pharmaceutical companies began making cholesterol medicines, which is currently a $3 billion dollar business.  

The new studies are showing that the LDL levels in patients having heart attacks is actually normal in 75 percent of the cases. So that means only 25 percent of the heart attack victims have elevated LDL levels. Now we know that having elevated LDL levels does statistically increases your risk of having a heart attack by about double. We are finding that too low of HDL may be as much or more of a risk factor for cardiovascular disease. HDL is the “good cholesterol” and we want it up up up.   Moreover there is evidence to suggest that these recommendations apply more to people under the age of 50. Having a little elevated cholesterol above age 50 may actually be beneficial to us.

The intent of researchers is to identify risk factors and then find interventions that can improve your health. The story with cholesterol is complicated, though. It does not appear to be so simple as identifying that magic number that if you can attain it you will protect yourself from cardiovascular disease. Lifestyle changes like eating less fats can probably only lower your cholesterol about 10 percent.  Exercise can lower your LDL and raise your HDL. The medicines called “Statins” can lower your LDL by as much as 50 percent and help raise your HDL. But the question here is does lowering your cholesterol result in you having less risk for a heart attack? There are just so many other factors involved. Having diabetes or being obese or smoking pose greater risks for heart attacks, especially combined with elevated cholesterol. In general, we have found a lower LDL and higher HDL is beneficial for the cardiovascular health.  As more research is done we will find cholesterol recommendations will become more individualized. But for now we have a generally applied set of recommendations for a general population.  

I always found it difficult to remember the desired results for cholesterol because they kept changing through the years. Currently the magic number for total cholesterol is 200 and below, triglycerides 150, for LDL (bad cholesterol) it’s 100 and for HDL (good cholesterol) it’s 60 or above. When you discuss your lipid results with your doctor they may have recommendations that differ from these standardized results. Be sure to ask your doctor, when medicines like statins are prescribed, will they lower your risk of death or heart attack in addition to lowering your cholesterol? For now the take home message is try to be as healthy as you can be. Eat a reasonably well balanced diet. Engage in daily exercise. Maintain a reasonable weight. Don’t’ smoke. Don’t put too much emphasis on your cholesterol.  

Remember to feel better,

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Dr. John Turner is a family medicine and emergency medicine doctor with 25 years of experience. He is also the owner of My Primary Care Clinic and My Emergency Room 24/7 here in Hays County. Dr. Turner may be reached at 512-667-6087.