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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