Diet/Fitness

bronxnjpeers

Cholesterol kinda high. 57 yr old man. Dr said change diet and exercise. I eat pretty good now, so not quite sure how it’s spiking. Exercise is limited due to rheumatoid arthritis and osteoporosis. I don’t drink or smoke! Really confused and frustrated. Any suggestions would be greatly appreciated.

Lietchi

I'm not sure what 'eating pretty good' means for you? What is a typical day?
And what are those cholesterol numbers? Which specific numbers are problematic? High LDL? High trigs? Low HDL?

Things that can improve cholesterol numbers:
- exercising more (it doesn't need to be high intensity)
- - losing weight if overweight
- increasing (soluble) fiber intake, for example oats
- increasing healthy fat intake (fatty fish like salmon, nuts, seeds, olive oil...)

AnnPT77

It's hard to know without knowing anything at all about your eating habits. I don't know what "eat pretty good" means. You might take a look at some diet plan on the internet (from a responsible source) that's designed to lower cholesterol, and see how that general style of eating compares with the way you currently eat. The so-called Mediterranean Diet is a common one that can result in lower cholesterol.

Most mainstream sources recommend high fiber (from food sources, not supplements), fish (especially fish high in Omega-3 fats), other healthy fat sources (nuts, nut butters, seeds, avocados, olive oil, etc.), whole grains, and plenty of varied, colorful veggies and fruits.

I had high cholesterol, and my doctor encouraging me to take a statin was a main trigger for me finally committing to lose weight. Like you, I already "ate pretty good", i.e., I had been vegetarian for 40+ years, ate lots of veggies/fruits, preferred whole grains, etc. But I was eating too much (class 1 obese), eating too many calorie-dense treat foods that have other nutritional down-sides (fried foods, baked goods), and that sort of thing. When I changed that pattern, I lost weight, and the weight loss brought my cholesterol down quite quickly. I still eat the same range of foods, but in different portions/proportions, and the treat foods are much less frequent - more because I was trying to limit calorie intake, not because I was intentionally choosing different foods for cholesterol reasons.

However, I don't believe I have a genetic tendency to high cholesterol, so weight loss alone was enough to make that significant improvement. If you have a family history of high cholesterol, it might be different for you.

Are there any forms of exercise you can do within your physical constraints? Even mild, manageable exercise can have benefits: Walking, pool exercise, gentler group classes for people with arthritis or who are older and not yet in good physical condition, etc.

I have osteoarthritis and osteoporosis, the latter severe enough to require medication. However, I've been fortunate to find ways to be quite active that work for me. (It took some cautious experimenting to reach that point, and I know that RA and OA pose very different issues.) I'm 68F, if that matters.

One thing to consider might be to ask your doctor for referral to a registered dietitian and/or a physical therapist for help figuring out how to manageably improve your eating and activity level.

Best wishes!

neanderthin

Talk to a specialist if you have any real concerns and there are tests available where a Dr. could easily attain to see if you have any arterial calcium buildup to show by % any risk you might have of any impending heart related event. Unfortunately Dr's aren't trained in that logic and are required by law to offer medication, mostly statins, it's the golden goose of the Pharmaceutical industry and training Dr's to delve deeper and perform calcium tests actually would produce a big reduction in revenue, and that is just never, ever going to happen.

Saying that, Cholesterol is for sure a risk factor but not in the way most people believe, including basic GP.

First of all there needs to be inflammation of the left and right coronary arteries. In other words there must be existing damage to these arterial walls before any metabolites, including cholesterol can infiltrate or get caught up within the endothelium before any damage can take place and over 90% of all heart attacks are directly related to those damaged endothelium which starts with that inflammation. Initially inflammation effects our "tight junctions" within the endothelium of those 2 arteries and tight junctions just mean the space between each cell and it's the gap inflammation causes where metabolites can then wiggle their way between those damaged cells.

Other metabolites besides cholesterol also get caught up within these damaged arterial cells that also contribute to more inflammation. For example lactate is one produced by glycolysis, which is the breakdown of glucose, sugar basically. Lactic acid is another one, Reactive Oxygen Species (ROS) which is caused by that existing inflammation which then contributes and produces more inflammation and ROS is a major cause of chronic low level inflammation within the entire body just not those 2 arteries.

Getting back to cholesterol and more specifically LDL, and more specifically yet, small, dense LDL (sdLDL) particles which are more likely to penetrate the arterial walls and contribute to plaque formation as opposed to the large buoyant LDL particles. Once inside the arterial walls, these LDL particles can become oxidized, leading to the recruitment of immune cells and the formation of foam cells, which further promote inflammation and plaque buildup. And it's this plaque build up, which is the calcium I previously talked about that then get more of the softer LDL cholesterol which then starts to calcify and create more blockage which inevitably clogs arteries or can break off causing blockages (clots) which can travel all through the body and effect lower limbs and the brain for example and cause embolisms to form.

The meat and potatoes of all of this is to slow down or stop that inflammation, do that and the coroner will not be checking off heart disease as a cause of our death, which at the moment is the leading cause.

What Doctors can actively do as well is look at our CRP levels (C-Reactive Protein) which indicate the level of inflammation in the body. The other major indicator of inflammation is our triglyceride levels, where when high, increase inflammation and that is basically caused by the overconsumption of carbs in general and the refined ones are what we are talking about mostly and sugar and when we stack that with the resulting obesity, and certain medical conditions like diabetes and liver disease (fatty Liver) caused by that overconsumption with other lifestyle situations like the lack of physical activity, excessive alcohol consumption, heart disease is a given.

Dietary and lifestyle intervention is what works. Consuming whole foods and it really doesn't matter too much which strategy we undertake for the most part and where something like a Mediterranean diet or a diet lower in carbs with a focus on protein, maintaining a normal weight with exercise also being integrated within that scenario, and if doesn't have to be some all out training session, it could be just walking everyday, but something then I'd say we're probably in good shape to dodge heart disease and of course don't smoke or drink excessively, just my opinion from what I gleaned from my research, for whatever that's worth.

ranmalih

Genetics can play a big role in cholesterol and heart health. That said, you can definitely do a lot in terms of lifestyle changes to help with this. Increasing your fibre intake can help lower cholesterol. Fibre is found in fruits and vegetables, but can also be taken as a supplement. Looking at the foods you eat and how they are prepared (eg vegetables can be "healthy " but deep-frying them might not be the best option).
As for exercise, start easy. Pick something you like doing, and you'll be more likely to stick to it. Walking is relatively easy - no special equipment needed and you can do it at a time/pace that works for you. If you have joint aches/pains, go walk in the pool. it takes the pressure off your joints and makes it easier to do.
I did see another poster about calcium scores - they were all the rage a little while ago, but as with every kind of test they can only tell you part of the story. They're good for showing calcium build up in the blood vessels around the heart. They don't tell you anything about the rest of your heart health - stress, sleep, blood pressure, diet, level of activity, alcohol, smoking, other health conditions..... so many other things have an impact too.

neanderthin

ranmalih wrote: »

Genetics can play a big role in cholesterol and heart health. That said, you can definitely do a lot in terms of lifestyle changes to help with this. Increasing your fibre intake can help lower cholesterol. Fibre is found in fruits and vegetables, but can also be taken as a supplement. Looking at the foods you eat and how they are prepared (eg vegetables can be "healthy " but deep-frying them might not be the best option).
As for exercise, start easy. Pick something you like doing, and you'll be more likely to stick to it. Walking is relatively easy - no special equipment needed and you can do it at a time/pace that works for you. If you have joint aches/pains, go walk in the pool. it takes the pressure off your joints and makes it easier to do.
I did see another poster about calcium scores - they were all the rage a little while ago, but as with every kind of test they can only tell you part of the story. They're good for showing calcium build up in the blood vessels around the heart. They don't tell you anything about the rest of your heart health - stress, sleep, blood pressure, diet, level of activity, alcohol, smoking, other health conditions..... so many other things have an impact too.

Yes, it's part of the story, it's the part that confirms a person actually has atherosclerosis, it is the determining factor. Stress, sleep, blood pressure, diet, level of activity etc are lifestyle factors that contribute one way or the other, depending on weather they're either in good standing or not and the propensity to contribute to either increasing or decreasing the susceptibility of inflammation, so yeah these do have an impact, but like I said, a person that has any calcium buildup in those particular arterial walls has heart disease, no guess work required.

A big contributing lifestyle factor for example is high blood pressure (hypertension). It works in conjunction with the mechanical stress generated by the continual rhythmic beating of the heart and the pressure (PSI) it generates has an effect and over time and this repetitive stress can contribute to the weakening and disruption of those tight junctions, making the arterial lining more susceptible to damage with high blood pressure increasing the PSI in those particular blood vessels which increases inflammation on a chronic level as well.

Basically high blood pressure is very much a concern where it can change the structure and functionality of those vessels. This increased inflammatory state is where those other lifestyle factors you mentioned like stress, diet, sleep etc can and does contribute to further inflammation which increase the permeability of the endothelium's cellular structure allowing harmful substances to infiltrate the arterial walls and increase the chances of atherosclerosis. It's all about inflammation and as far as cholesterol is concerned it's those lifestyle factors you mentioned which determine whether the particle size are predominately small and dense or large and buoyant LDL and the status of our inflammatory state along with the level of triglycerides we have.