Health by the Numbers: A Closer Look at Cholesterol

It has been my goal to only write to this blog about those subjects I have personally experienced. As it stands now, the list of topics we might explore will not grow short any time soon.

My new-found curiosity for emergency medicine has not made me more inclined to visit a doctor. Nonetheless, after a fair period of procrastination, I found myself sitting in the stiff, blue chair next to our family doctor’s desk where we were reviewing the papers I held in my hand – my blood tests. There were no real surprises on the first page, and then I nearly fell out of my chair on the second page. My cholesterol was 241.

The very word scares me to death, and I have spent an entire week analyzing my number. Most of us don’t remember a time that low cholesterol was not the most sought after condition on Earth. While the research to validate this approach has helped me understand my condition, it has also been both maddening and overwhelming.

The twist in my “high” number is that my HDL, what we know as good cholesterol, was 100 (the good range is 35-65). My doctor rather quietly admitted he had only read about a man whose HDL measured 90, but had never even heard of anyone’s HDL measuring 100.

Understanding the Beast

Cholesterol is vital to every cell membrane on Earth. It helps produce hormones, the formation of our memories, and is vital for neurological function. Cholesterol is even used to interact with sunlight on our skin to convert it to Vitamin D. The real skinny on cholesterol’s components is this….

  • High-density lipoprotein (HDL): helps to keep cholesterol away from your arteries and remove excess plaque;
  • Low-density lipoprotein (LDL): the “bad” cholesterol that may build up in your arteries, forming plaque;
  • Triglycerides: elevated levels of this fat has been linked to heart disease and diabetes;
  • Lipoprotein: made up of LDL plus protein, elevated levels indicate high risk for heart disease.

….the sum of which does not necessarily tell you anything.

The K-Factor

The earliest part of the cholesterol story began in the 50’s when Manhattan businessmen were growing thick around the middle. Meanwhile, statistics from Northern Europe showed that as food supplies became short the death rate from coronary heart disease dropped. This led an American scientist, Ancel Keys, to launch a study to discover the factors involved in the degeneration of the heart. Ultimately, Keys hypothesized that a diet low in animal fat protected against heart disease (a diet hard to come by in war-torn Europe) and that a diet high in animal fats led to heart disease (a diet favored by prosperous Americans of the time).

After publishing his findings in what became known as the Seven Countries Study, the 1956 American Heart Association announced that a diet which included large amounts of butter, lard, eggs, and beef would lead to coronary heart disease. We largely adopted this strategy until late 2011 when the truth about Ancel Keys declared he had gotten it all wrong.

Keys was a fascinating and brilliant man who died just two months before his 101st birthday. He was responsible for creating balanced meals for combat soldiers in World War II, ultimately named K-rations, and he popularized the Mediterranean diet. He carried out a starvation study (Biology of Human Starvation), helped promote the body mass index (BMI), and assembled the first team to study the effects of high altitude on the body.

Science, diet and health were central themes in his life and it is no doubt safe to claim he was instrumental in linking diet and health for all of us.

Cholesterol, the “invented” disease?

Fast forward to 2004 when the American Heart Association (AHA) recommends that total cholesterol be less than 200 mg/dL.(Some would say total cholesterol is inadequate in determining the risk for heart disease unless it is above 330.) Additionally, the AHA updated their guidelines in that same year to recommend lowering LDL from 130 to less than 100, targets typically unachievable for many Americans without cholesterol-lowering drugs.

In a 2006 review, the Annals of Internal Medicine found insufficient evidence to support these new target numbers, and it was disclosed that eight of the nine doctors on the panel had been making money from the drug companies that manufacture statin cholesterol-lowering drugs – a $17 billion U.S. market in 2011-2012.

A quick look at the message boards revealed I was not alone in my quest for understanding the cholesterol beast.

A 19-year old female vegetarian, endurance athlete was diagnosed with high cholesterol (237), HDL: 90, LDL: 143 and Triglycerides 62.

Another ultra-endurance athlete disclosed his own cholesterol levels: HDL: 152, LDL: 111, Tryglycerides: 64, for a total whopping number of 278. He had been prescribed statins when he got a second, more informed opinion.

My numbers include HDL: 100, LDL: 124, Tryglycerides: 83 for a total of 241.

Hyper-alphalipoproteinemia (HDL-Cholesterol > 80 mg/dl) may be caused by several factors, including fairly rare genetic mutations, excessive alcohol consumption (which is why moderate alcohol consumers have reduced rates of cardiovascular disease), high intake of niacin (raising HDL levels up to 30%), long-term low carbohydrate dieting (such as with Atkins), and exhaustive aerobic exercise (interestingly, distance runners and weight lifters are known to have elevated HDL levels while century cyclists may not).

There have been so few studies of individuals with HDL levels above 100 that a conclusion is difficult to discern. Some research eludes to the level being indicative of under-lying issues, while other research suggests the condition as being hereditary. A more familiar discussion involves the longevity gene. My doctor believes a person’s HDL number directly corresponds to that person’s age at death (the infamous retirement calculator is being updated as we speak).

Whatever you believe, there are key points to consider when it comes to evaluating your own health:

  1. There are risks associated with lowering cholesterol too much, including depression/higher suicide risk or aggressive behavior, while other studies have linked low cholesterol to Parkinson’s disease.
  2. As with many drugs, statins have been linked to a number of serious complications, dangerous side-effects, and mis-leading effectiveness as compared to a placebo or sugar pill. The New York Times reported in 2012 that taking statins makes it harder to exercise because of damage it causes to the muscles. Get a second, or third opinion before accepting medication as the first, or only solution.
  3. Have your cholesterol tested and follow these guidelines to determine your overall risk for heart disease — HDL/Cholesterol ratio and the Triglyceride/HDL ratio. Divide your HDL level by your cholesterol – that percentage should ideally be above 24%. Do the same with Triglyceride divided by HDL – that percentage should be below 2. (Using my numbers as an example: 100/241 = 41% and 83/100 = 0.83.)

A Harvard study, published in the journal Circulation, showed that the people with the highest ratio of triglycerides to HDL had 16 times the risk of heart attack as those with the lowest ratio of triglycerides to HDL. In fact, the ratio of triglycerides to HDL was the strongest predictor of a heart attack, even more accurate than the LDL/HDL ratio.

As for me, I plan on having my cholesterol tested again in a few months as a double-check. Meanwhile, I’ll keep running…. and I’ll keep writing the tale of my life as a runner.

Additional reading on understanding cholesterol:

The Cholesterol Conundrum – The Saturday Evening Post

The Cholesterol Myth That Could Be Harming Your Health (The Huffington Post)

The Truth About Ancel Keys: We’ve All Got It Wrong

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