Cholesterol question from cyclingnews.com

Below is a question and answer reprint from cyclingnews.com fitness section.

Cholesterol level

I have a question about cholesterol levels, diet and exercise. Background is this: I’m 59, 5’11”, 155 lbs. I ride around 150 miles a week- a lot of it packed in on weekends, plus I run every day for a weekly total of 30-35 miles. I’m a strict vegetarian on a very low fat diet (no added oil apart from what I get in tofu and soy milk, plus 3g of flax oil per day).

I do eat non-fat milk products in the form of yoghurt and take a full suite of vitamin supplements including several grams of Vitamin C daily (I haven’t had a cold in 20 years). I recently had a fasting blood test where my HDL was low at 34 against a total cholesterol of 125. My doctor without any discussion apart from the fact he knew I exercised and had a healthy diet, prescribed Pravastatin to change my HDL/LDL levels.

I have several questions regarding what I can do about raising my HDL without resorting to a statin drug with known side affects including muscle pain and soreness (the last thing I need). I’ve also read that statin drugs don’t actually raise HDL so I’m puzzled by the prescription. I was surprised by the bloodwork results since I haven’t ever had a bad ratio like this before and my parents had no history of high cholesterol or heart disease. My exercise, diet, and weight have been pretty constant for a number of years.

Since I already have a decent volume of moderate intensity aerobic training, would changing this affect HDL? More miles higher intensity? Would weight loss have any affect on these blood values. I used to marathon at 10 lbs less but I was always courting illness and injury.

Could my diet be too low in healthy oils? Everything I eat is non fat or has very low natural oils. I eat no transfats or saturated fats. I did read that flax oil and Vitamin C supplements can suppress HDL readings so I don’t know if either of those might be an issue.

Are there other dietary supplements that I might try rather than taking a statin drug for these cholesterol values?

Since I don’t have any risk factors other than the low HDL, I’m interested in pursuing alternative solutions before resorting to drugs like this. Any thoughts would be much appreciated.

Bob Bolin
Boulder, Colorado 

Kelby Bethards replies:

 

You bring up an interesting point. We live in a sedentary society. Thus, your doctor’s inclination to give you pravastatin. We tend to see people that unfortunately wouldn’t run to catch a pay cheque. That being said, onwards.

 

An HDL of 34 is a bit low. A bit low for what? Cardioprotective effects. You said your total cholesterol is 125, or is that your LDL? The reason I ask is if your LDL is 125, that is a different story than if your total is 125. If your total cholesterol is only 125, then your ‘bad’ cholesterol (LDL) would be low. We, as physicians, are trying to lower bad and raise good cholesterol. HOWEVER, you are doing some of this on your own by exercising.

You are correct in how to lower your LDL and raise HDL… exercise. You have a genetic predisposition if your HDL is low. Niacin, vitamin B3, can raise HDL levels and lower cholesterol; however, it can give people a hot flushing feeling after taking it for about half an hour. Any treatment can have side effects, and those need to be considered.

If the risk of the medicine does not justify the benefit, then it isn’t too useful. For most, pravastatin is useful. But you have pointed out that your only risk factor is a bad HDL (not a diabetic, not a smoker, no prior heart disease, no high blood pressure, no family history – assumptions I’ve made). So, you need to re-visit your practitioner and press it again… do you need pravastatin? Or why do you need it?

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Pedal your way to heart health.”…stronger now because of the bike riding.”

“For Joe Sontag of Kirkwood, it IS about the bike.”
“The bike has been a big part of his salvation and the ticket to his physical and mental well-being…”
“Last October, he rode his first Century — 100 miles, in one day.”
” My heart will never be totally repaired, but it is so much stronger now because of the bike riding.”
““Bicycling is better than anything I’ve ever done, or any prescription I’ve taken, to relax myself.”
Published Sunday, July 20, 2008

Hooked on pedal power three years ago after surviving two heart attacks.

“Mountain biking is the new golf for Wanaka man Keith Broadhead (70), who became hooked on pedal power three years ago after surviving two heart attacks. Since his revival in a doctor’s surgery and the insertion of four stents, Broadhead has survived on a daily diet of adrenaline created by cycling at least 16km on weekdays, sometimes after playing 18 holes of golf. On Sundays, he cycles 40km.”

Read the full story here.

Listening to your body not your imagination.

It now gets dark at the home of the HAR around 5:30. I’ve been anxious to get back on the bike since I have only gotten 2 rides after my sinusitis left a week ago. I put on some “cold” weather gear (62deg. brrrr!:)) strapped on the Garmin monitor and rigged up the DiNotte. At night I just ride through my neighborhood.I love the anonymity, isolation and introspective thoughts that riding at night gives me. Since I live in a Southern California suburbia style planned community(no, I’m not a republican) most people are home eating dinner, so cars are hardly ever an issue.  I have not been out riding much and I expected my HR to be higher than normal. I did my usual 10 minutes warm up and thought about doing a short loop of 40 minutes or so. I felt good, maybe even strong for the first mile. The first hill is easy I usually am in the 140bpm area. This time my Garmin sounded the beeping alarm to tell me” Your in the the 90% range!”, I was at 157 bpm. ? O.K. no big deal. A short down hill then I stood up for a 30 sec effort up the next hill……161bpm ? ! Now my max is supposed to be in the 177bpm range. My last cardiolite test the docs maxed me out at 162-165bpm so that is up there for me. Hmm this is unusual even for me. I kept going 1/2 mile straight then another roller to get out of the saddle on…….again 160 quickly….hmm. I was always told by my doctors that if I feel fine it’s O.K.* and that I’m free to exercise at that heart rate. I coast down a small false flat then swing a U turn and go for another out of the saddle effort to that far away light post then a high rpm effort to the stoplight…about 1/2mile in all. As I almost got to to the street light a bit of chest pain, specifically it was sort of sharp 7 dead center radiating. I coasted down a steep hill then tried another good pace on the flat…still not feeling great. This is when I started to worry. “Not another problem?”, “Do I have to tell my doctor about this?”, “Is it just the cold air?” or “Maybe it’s the Tofurky from lunch?” I was almost done so back up the first little hill from the beginning of the ride then home. Back to 156-160bpm, arrrrgh and a diff location of discomfort, more in my upper chest. O.K. so I’ll just stand up for 1/2 a block hill and head home I thought. As I turned the corner I got in a good cadence but was more nervous than in discomfort. Whenever I get these types of pains and thoughts I try to slow down and ride through them before I make any real decisions to stop or grab a Nitro hit or pop some baby aspirin. I have a 75 yard 60 vertical feet climb back to my street after my cool down. When in shape I hit 125+bpm or 140bpm other times, tonight 156bpm….more food for my thoughts. I then spin in the easiest gear home, 3-4 minutes until my HR goes down. No problem there, same as always 115bpm in the garage and 98% oxygen on my meter. I still feel something that isn’t indigestion and isn’t chest pain either, it’s making me nervous. Not enough to go to the hospital.

My sis and brother in law come over to help me move some furniture, again just keep going and didn’t think about it and see if the pain goes away. It didn’t and I probably should not have moved that bookcase. I need to go to the market now and as I always do I grab my wallet, cell phone and nitro/aspirin bag. I take a hit of Nitro as I get in the car. Now this is NOT RECOMENDED. I have taken Nitro many times and know how it effects me so I feel safe driving having taken it. I’m in the market 7 or 8 minutes later looking at the magazines and feeling a little dizzy (probably the Nitro, but not sure) and my chest is still feeling “funky”. To be on the safe side I pop 2 baby asprin and continue shopping. As I call Mrs. HAR to make sure what flavor of juice she is craving (she’s 8+ months pregnant), reading labels and deciding if the the broccoli I’m holding is too wilted or worth buying if I eat it tomorrow I notice that I no longer feel any pains, dizzy or anything I would consider cardiac related.

Enjoying the seat warmers on the drive home (remember, it’s really cold here) I think about how often I have let my mind over take my knowledge. Knowledge only I can understand because I have lived through any pain I could ever get from a cardiac issue be it immediate emergency care or the “MAN! I can’t believe I need to tell my Dr. about this and need another test” pain. SInce I had my heart attacks I have tried to keep a mental spreadsheet or chart of pains, feelings and emotions. I believe, and have been told,  my body will tell me almost all of things I need to know. If I can learn what it’s saying and how it’s saying it then retain that information to recall when these “episodes” arrive it will help me enjoy my rides more often.

* After annual cardiolites every year since my heart attack, many ultrasounds, cameras in my veins, and continually discussing my physical activities my doctors came to this conclusion.

* Never try anything I do or base your actions on mine without consulting you doctor(s). I have had clearance & or testing done to determine if what I’m doing is reasonable/safe for me to try. This website is not meant as any substitute or suggestion of medical advice, It is mearly a documentation of my experience(s).