I’m 33 years old who exercise very regularly. I do mean almost everyday - barbell strength training 2 - 3 times a week and I run about 25 miles weekly. I’m in fairly good shape with low body fat (<11%) so I’m really surprised when I learn that I have elevated bad cholesterol (LDL >200mg/dL, HDL > 60mg/DL, TG < 60mg/DL). I also don’t smoke and I’m not aware of any other family members with cholesterol problems.
My diet has room for improvement - I drink a lot of whole milk (preferred protein source) and maybe too much seafood/red meat/butter. However, with LDL this high (despite the exercise volume), I’m not sure I can bring my LDL down to healthy levels with diet modifications alone. Do you think I should go straight for Statins? If I choose to take medication, does it mean I can continue to eat seafood and stake?
I’d first recommend reading our main articles on this topic:
I don’t think that whole milk or seafood are likely to be the major contributors to these lab findings, however. High consumption of butter and red meat are probably the bigger drivers, as well as potentially some genetic factors.
It is tough to predict exactly how much progress you’d make with lifestyle changes alone vs. with medications, but we do know that dietary changes can have measurable impacts on blood lipid panels relatively quickly. I suspect that if you were to substitute out most/all of your butter intake, potentially substitute/replace some of your red meat intake (depending on the type/source and leanness of cuts you consume), and significantly increase your intake of fiber (from fruits like berries, all vegetables, oats, and/or legumes like lentils/chickpeas/beans), you would see detectable changes in the blood test within 4-8 weeks. At that point things could be re-assessed (repeat blood lipid panel, and ideally an apoB and one-time Lp(a) measurement) to determine the best course of action. We’d be happy to consult with you privately at that point if you’d like.
Thank you for your reply. Those are great articles with lots of good information. I read through all of it, including the 3rd one.
My doctor thinks I should start taking Lipitor immediately. That’s probably the most logical thing to do but I’m a little hesitant; while I think it’s ok to benefit from modern medicine, I’m not fond of the idea of having to rely on drugs for the rest of my life. I’m the kind who uses hook grip instead of straps - no medals for that but it makes me feel independent and in control of things.
Seems like my other other option is to include for vegetables and fiber in my diet - something I know I’m not eating enough. I’m already exercising 6 - 8 hours a week so I’m not sure further increase in exercise volume is going to help bring it down. Plus I have a full time job.
To be honest, I know my diet is less than ideal, but I didn’t think it was that bad. At least I try to avoid fast food, process food and only consume alcohol in moderation. I say it’s not that bad because my wife had her lipid panel done at roughly the same time but has very different lipid profile despite sharing similar diet. She has much smaller caloric balance but the % of total calorie she consumes in animal fats and butter is similar. Don’t regular exercise help to offset some of the bad diet? I can’t help but think that I also have the genetic bad luck of having the certain mutation that cause high LDL.
I’Il schedule another blood test in 4 - 6 weeks and ask my doctor about the apoB test that you wrote about; though I don’t think I’ll do very well in that either. Even if most of the LDL are pattern A (bigger particles), I’d still end up with high particle counts.
The other worry I have is I’m not sure how long I’ve had this elevated levels of LDL… could be several years. Is there a way to find out? I’m trying to understand my current risk profile. I have decent cardiovascular endurance, so things can’t be that bad right? My blood pressure is also normal - 110/60.
While I understand this common line of thinking, as you now know a substantial portion of this risk may be genetically influenced, and is thus necessarily outside of your control. In which case it doesn’t make sense to avoid simple, straightforward methods to reduce your lifelong risk just because they are medicines. In fact, if things do end up being principally genetically driven, taking medication may be the only remaining option you do have to take control of things rather than living with unnecessarily high risk.
Right. There’s a reason I didn’t recommend more exercise here. The recommended dietary substitutions may help, and I don’t think that putting these into practice and seeing how things turn out in 4-6 weeks would be dangerous or risky, prior to making your final determination regarding medication use. If you are unwilling or unable to make those changes, your remaining options narrow even more, aside from medicine.
There is no way to find out how long you may have had elevated levels at this point. And while good endurance is a reassuring finding, it does not mean much with respect to your long-term/lifelong risk if you were to continue having elevated blood lipids.
Thank you for your advise - that makes a lot of sense. I’ll follow your diet recommendations and monitor my progress in 4 - 8 weeks.
Will go RPE9 on veggie consumption for now.
Final question:
My current LDL is about 203. Is there a range or % reduction that I should shoot for in 4 - 8 weeks? That if I don’t achieve that target then medication would be recommended?
I really appreciate the work you are doing - I’ve previously benefited from your talks about RPE/programming (was previously doing RPE 10 once per week until I hit plateau and now making progress again); and now you are helping me navigate through all this. You influence my life in many ways!
If your non-HDL-C remained elevated above 130 mg/dL I would be more inclined to consider medication use. The caveat is that if you get your Lp(a) checked and this is significantly elevated, then I would be much more aggressive with non-HDL-C (or ApoB) lowering.
Glad you have found our work helpful. Feel free to contact us for a consult when you get your subsequent results if you’d like further guidance.