Why Is My LDL Cholesterol High?

Transcript:

MELANIE: Welcome to Dishing Up Nutrition. We're a company specializing in life changing nutrition education and counseling. With so much nutrition noise out there in the media, we are passionate about bringing you a science based research platform on nutrition information as well as health information. And there's a lot of misinformation around today's topic.

So, you'll want to listen pretty closely, and if you're at home, maybe get out a pen and a paper, because we're going to be throwing a lot of information at you, and you might want to take some notes. My name is Melanie Beasley, and I'm a Licensed and Registered Dietitian. I've been in the field for over 30 years. And I'm still surprised at all the nutrition misinformation that is out there surrounding cholesterol.

BRANDY: I'd have to agree, Mel, like totally. The clients that I meet with who want to talk about their cholesterol numbers, they come in, their cholesterol is high, and their impression is that their cholesterol is above 200, that automatically means that they're at risk for heart disease.

MELANIE: They're kind of panicked.

BRANDY: They are panicked. They're freaking out. And, you know, that's a major reason people come in to talk with us is because they want to get these numbers under control. And the LDL cholesterol is another number that they're really concerned about. So if that number is high, they're really scared.

So that's what we're going to talk about today. And maybe you've recently had your physical done and you've had your cholesterol levels tested. And maybe your doctor came back and said, your cholesterol is high, your LDL cholesterol is high. We need to tackle this. So, in this show, we will give you all the answers you need to understand your cholesterol a little bit better.

MELANIE: Yes. Yes. And so you, everyone can just take a deep breath.

BRANDY: Yes. Yes.

MELANIE: And understand what's going on.

BRANDY: Yes. And my name is Brandy Buro. I'm a Licensed and Registered Dietitian and I'm really excited to be here with you today, Mel. It's been a while.

MELANIE: I know. This is so fun to be here in studio with you this morning. Well, I have a question for all of you listening. Have you been to the doctor to get your blood work? And I want to ask you, did you get a printout, and did you break it down for yourself to understand your cholesterol levels? How closely did you look at the numbers if you got the printout? Maybe you were focusing on your total cholesterol number, or did you have someone break down all the other components for you?

The importance of having the complete cholesterol panel breakdown

Your cholesterol lab work is sometimes called a lipid panel, and the definition of lipid is a fatty, waxy, or oily compound. Usually, in a lipid or cholesterol panel, you will receive these numbers like your total cholesterol, HDL, your LDL, and your triglycerides, and those are the numbers that we like when you come to an appointment; we like to see all of them.

BRANDY: Yes. So, any time a client comes in, they want to talk about their cholesterol, I am just crossing my fingers that they have that complete panel with them that they actually know what the details are of those four things: triglycerides, HDL, LDL, and that total number.

MELANIE: It's, the beauty of technology is they can pull it up on their phone.

BRANDY: Yeah.

MELANIE: Happens all the time.

BRANDY: If they remember their password. But, yeah. And I find that when my clients do bring me a copy of those lab results, they're usually hyper focused on just that one number, that total cholesterol. So that is a myth that is still going around that, and even within the medical world, that if the total cholesterol is over 200, it's a big deal. It's an issue.

MELANIE: Yes. The general standard that doctors use is that total cholesterol. So, let's take a little step back because I want to talk about why people are concerned about their cholesterol numbers in the first place. What's the big deal?

Cholesterol numbers are NOT a good predictor of heart disease

Well, it all gets back to the risk or the fear attached to heart disease. Now, being conscious of heart disease is wise because it's still the number one disease that causes death in our country, but cholesterol numbers are not a good predictor of heart disease. Surprise!  

BRANDY: That's right. So I think that's a really important statement, and I think it's worth repeating, so I'll say it again. Your cholesterol numbers are not actually a very good predictor of your risk of developing heart disease. So here are some statistics on heart disease and its relationship to cholesterol. So there was a study published in the American Heart Journal that found nearly 75 percent of patients hospitalized for a heart attack actually had LDL cholesterol levels that were normal.

MELANIE: Wonderful; yeah. Good to know.

BRANDY: So most people that were hospitalized for that heart attack had LDL numbers that were not, you know, flagged as high risk. And 50% of people with LDL cholesterol that was in the high range, or you know, the at-risk range, they didn't have any heart concerns. They had healthy hearts. So why is this still a concern? Why are people so worried about getting their cholesterol numbers down?

MELANIE: Yes. It brings to mind a client of mine I had who was, oh gosh, 50 years old and he ran, played golf, fit, ideal body weight. He'd been on a statin for eight or nine years and had to have a triple bypass surgery after having myocardial infarction, a heart attack. And so that really wasn't his risk factor what was happening. There were other things at play, which we worked on. I got him after the fact.

BRANDY: Yeah.

Faulty research influenced cholesterol myths

MELANIE: And we've talked on previous shows about faulty research that was done by Ancel Keys in the 1950s and how that influenced all of these cholesterol myths. I think it launched us into the low fat craze of the 70s, 80s, and 90s where actual heart disease escalated.

BRANDY: Right, right. So for, you know, the last 50, 60 years we've been on this low fat train, but it's not really giving us the results that we expected it to. So time to go back to the drawing board. Huh?

MELANE: And it's time to get up on the current research. And what actually does cause heart disease? So the, that old faulty research is really hard to squash once it's out there. Especially around cholesterol and plaque. So, that buildup in the heart and the, the resulting of heart disease, the fear of fat has lingered for decades, especially the fear of cholesterol. And frankly, it's made people terrified of fat and cholesterol, and that's not a place we want to live in. Because as we talk further, those are our friends.

BRANDY: Right. Fat is your friend.

MELANIE: It is not the enemy.

BRANDY: Definitely, yeah, and hopefully you walk away with that message at the end of our conversation today that fat is not the enemy, and we'll be talking about what things are actually causing issues with your heart.

MELANIE: Right. Good.

BRANDY: And the good news is that some of the guidelines are catching up to this science. In 2015, the Dietary Guidelines for Americans removed their recommendation to limit foods with cholesterol, and they updated their guidelines to reflect that. So hallelujah.

MELANIE: Hallelujah.

Cholesterol: no longer a nutrient of concern

BRANDY: The guidelines now say that cholesterol in foods that contain cholesterol are no longer a nutrient of concern when it comes to heart health.

MELANIE: No longer a nutrient of concern. So write that down, readers, if you've got that pen and paper. Cholesterol is not the concern for your heart disease. But what foods contain cholesterol? You know, when we think about that, most people think about eggs. Egg yolks specifically, butter, beef, pork, shrimp, poultry.

So are you someone who has avoided maybe the poultry skin, right? These foods have you a little bit afraid of high cholesterol and the cholesterol we're getting from our diet is not what causes cholesterol in our blood to go up.

BRANDY: Right.

MELANIE: Yeah.

BRANDY: And when I share that information with, like, class participants or my clients, they are just simply shocked. You know, I mean, they have been living their lives avoiding these foods because they think it's increasing their risk of heart disease. Some of my clients are actually a little irritated when they learn that because they've been spending their whole lives avoiding butter, avoiding eggs, and…

MELANIE: These are delicious foods.

BRANDY: Delicious foods and for what?

MELANIE: I'd be annoyed too.

BRANDY: For what? Yes.

MELANIE: So, you're listening to Dishing Up Nutrition, and we're talking about cholesterol today. The myth that eating foods that contain cholesterol will increase cholesterol and lead to higher risk of heart disease, well, this myth has been going around for many, many years, and it's not the egg yolks or the red meat or the butter that are the cause, and you might be wondering, what foods are the culprits? Well, stay tuned because we'll tell you when we come back from break. We'll be right back.

BREAK

BRANDY: Welcome back to Dishing Up Nutrition. I'm Brandy Buro, a Licensed and Registered Dietitian, and I'm here today with Melanie Beasley, a Licensed and Registered Dietitian. And before break, we were talking about how certain foods have been demonized for increasing your risk of heart disease, particularly those foods that contain cholesterol:

Sugar & refined oils can cause high cholesterol

Eggs, red meat, butter are kind of the top of the list for a lot of people. But they've been wrongly accused of causing high cholesterol. It's actually sugar. Sugar and refined oils create the biggest risk for our heart health. They are the types of foods that can actually damage your blood vessels. And when your blood vessels become damaged, that's when the plaque starts to build up.

What can cause damage to the blood vessels?

So when your blood vessels get those little nicks and tears, plaque buildup occurs because it's trying to repair the damage that's been done. And the more that plaque accumulates, blood can't flow as freely and that's when we're in trouble.

MELANIE: So that's, I want to expand on that a little bit. So when we have anything that can create those little tears, nicks, damage on the inside of the vessel wall; it could be high blood sugars, could be high stress, could be medication, smoking, alcohol; when we get those nicks and tears, the LDL cholesterol is the patching material that comes along and basically is a little band aid and it patches that up.

Overviewing LDL & HDL cholesterol

Well, if you continue to have nicks and tears, you can imagine that those band aids build up. And as the band aids build up, it closes down the blood vessel and it gets more and more narrow. That's where the cardiac risk is because a piece could break off, cause a stroke or heart attack or completely become occluded and that's where we have issues as well. So the LDL is actually our patching material. It's not really our enemy.

And the HDL, the high density lipoprotein we're going to be talking about is our friendly escort. And so it picks up that LDL and starts clearing it from the system. So that's why we want the HDL high. H for high and the LDL low, which means we're not having to patch damage. So, I hope that clears up. It can be, those numbers can be so confusing.

BRANDY: Yeah, definitely. A lot of people don't even know what they mean or even look at them. Again, I think most people are hyper focused on that total cholesterol number, not really paying much attention to their HDL and LDL, so we're going to kind of break that apart a little bit more today.

MELANIE: Yeah. I like that.

Avoid refined, damaged fats

BRANDY: Yeah. So again, it's not the red meat. It's not the butter. It's not the eggs. What we really need to be concerned about is the refined oils, things like canola oil, soybean oil, cottonseed oil, those factory oils, right?

MELANIE: The factory fats.

BRANDY: And you're going to find those types of foods in pretty much any fast food restaurant you go to, anything that's deep fried. So those are really good clues. You got to stay away from those as much as you can.

And it's also going to be found in, I would say, 99 percent of processed foods. So things that come in a box or a package. Things like chips and crackers and muffins or…

MELANIE: Even if they're gluten free.

BRANDY: Even if they're gluten free.

MELANIE: They're processed foods.

BRANDY: Exactly. Exactly. Even if they're marketed as a healthy food, take a look at the ingredients list and look for those refined oils.

MELANIE: And another one that's sneaking in right now is sunflower oil.

BRANDY: Mm hmm. Sunflower oil.

MELANIE: That's, it sounds like it should be healthy. But it's a refined franken fat, so we want to not be eating that.

BRANDY: Yeah. So beware of those terms: vegetable oil, sunflower oil, soybean oil, corn oil, cottonseed oil, even canola oil. Those are all those factory fats that can spike cholesterol, increase your risk of heart disease.

MELANIE: So it's almost easier to think, what are the good oils?

BRANDY: Right.

MELANIE: Coconut, avocado, butter, ghee. Those are, those are your good oils to be looking for.

BRANDY: Yep. Natural fats.

Factory-made oils + sugar/processed carbohydrates = deadly combination

MELANIE: You know, those factory made oils, when they're paired with too many sweet treats or processed carbohydrate foods that we were talking about, that combination, that's the deadly combination. Because high sugar with those bad fats is really the enemy for your heart health. That's the enemy. It's not the real food cholesterol you're getting from your beef, which later on that's going to put you for risk for cardiac event. So we want to be looking at what are your blood sugars? What kind of oils are you eating? Are you eating processed carbohydrates like crackers, cookies, biscuits, pancakes and so forth?

BRANDY: Exactly. Yeah. And I like that term deadly combination. I was going to say the exact same thing.

MELANIE: Were you?

BRANDY: Yes. The refined oils and the refined carbohydrates: deadly combination. And you're often going to find that combination in most of your processed foods.

MELANIE: Well, if you think French fries, when you eat out, right? It's a processed oil. It's a franken oil. It's been heated time and time and time and time again for French fries over and over and over. So now it's become a trans-fat and now you dunk some potato in there that turns rapidly to sugar. There's that deadly combination and you think I just had a potato.

BRANDY: Right. Yeah. Not as innocent as you think. But we actually do need a certain amount of cholesterol for our health and keep that in mind. So like cholesterol itself is not the enemy here.

Cholesterol is a vital nutrient to maintain optimal health

MELANIE: It's like you said earlier. It's a vital nutrient.

BRANDY: It is. It actually plays many roles to maintain optimal health. And just to give you an idea of what cholesterol actually does in our body, for one, it provides an important component of the structure of every single cell in our body. And we also need some cholesterol to make certain hormones, especially reproductive hormones: testosterone, progesterone, estrogen.

And another role it plays is it helps us make bile. So bile is a substance that helps us digest and absorb fats, those healthy, nutrient rich fats. And it's also really important to help us produce vitamin D. And I think we're all aware at this point how important vitamin D is for our health.

MELANIE: Yeah, good point. That vitamin D is critical.

BRANDY: So that's why as dietitians and nutritionists, if we see a client's cholesterol that is too low, that's when we actually get a little concerned, right? And it's also really crucial for our brain health, too. So just keep that in mind.

MELANIE: Because we have fatty brains. Our brains are primarily made up of fat.

BRANDY: Mostly fat, right?

MELANIE: And cholesterol.

BRANDY: So I want you to keep that in mind, listeners, knowing that too little cholesterol could actually be an issue. So that's something to keep in mind when you're looking over your cholesterol results, when you're having that conversation with your doctor about what they mean and, you know, whether or not they're encouraging you to start a cholesterol lowering medication.

MELANIE: Mm hmm. Is it a good idea for you? Well, here's an example of how much our bodies require a certain amount of a cholesterol for overall health. Let's say you're someone who's avoiding all foods that contain cholesterol, saturated fat. So maybe you’re the baby of the 70s. Maybe you heard from someone, a family, a friend, a coworker, or even your doctor that high cholesterol causes heart disease.

So, you do your due diligence and you cut out all red meat and you switch from butter to margarine and you start buying egg whites instead of the whole eggs with the yolk. Well, because your body is so smart, it will still produce cholesterol. In fact, most of the cholesterol floating around in our bloodstream is produced by our liver.

BRANDY: Yup.

MELANIE: So, the body knows it's a vital nutrient and will kick in making its own cholesterol from the liver.

BRANDY: Right. Yeah. So at the end of the day, even if you are bending over backwards to avoid foods that have cholesterol in it, your liver, it's going to do its thing. It is going to make cholesterol so that you have the cholesterol you need to support your cell membranes, to make vitamin D, to make bile, and those hormones we talked about:

Estrogen, progesterone, testosterone. And again, for brain health. The solid matter of our brain is about 60 percent fat and a quarter of all the cholesterol in our body is actually needed just to maintain optimal brain health.

MELANIE: Oh, I'm glad you pointed that out. Yeah. Yeah. It's so important for memory. So you think about all the people that are struggling with memory issues as they age, perhaps this is the culprit or one of the culprits, right?

Breaking down the different cholesterol numbers

So what do those cholesterol numbers mean anyway? Well, your total cholesterol is just a number that is basically adding your HDL and LDL together. There's a little more math in that, but that's why it's called total cholesterol. So when someone comes to me and they're worried about that total number, there's more to the story.

BRANDY: Yes, exactly. And I've got a client story I'd like to share a little bit about.

MELANIE: Oh, good. Story time.

BRANDY: Yes. So I had a client that came in recently. He was really worried about his cholesterol numbers, just had his physical done. And for the first time, it was flagged as high. His total cholesterol was flagged as high. So his total cholesterol was actually 240. And his doctor was on, and he's like, we got to get you on a statin. We got to get this number down.

But because this was the first time that number was elevated, you know, my client was like, I think I can try a few things on my own before I start a medication. So that's why he met with me.

MELANIE: Good for him.

BRANYD: He wanted to figure out, yeah, just wanted to figure out, you know, take some time. Is there something I can do through food to get my numbers back in a better range?

MELANIE: I want to hear about this so much, but we have to go to break.

BRANDY: Yes.

MELANIE: You're listening to Dishing Up Nutrition. We're talking about cholesterol today and doing a deep dive into why cholesterol alone is not a good barometer for your risk of heart disease. Heart disease is a big concern because it's still the number one cause of death in our country. In fact, every 39 seconds, someone in the U.S. dies of heart disease. That number causes me to pause. We're going to talk and help you out when we come back from break.

BREAK

BRANDY: Welcome back. You are listening to Dishing Up Nutrition. Our topic today is why is my LDL cholesterol so high? And before we went to break, I was sharing with you all a client story. My client came in, he had his physical done, and his results indicated that his total cholesterol was high. So he's a little worried. He wanted to meet with a dietitian just to see is there anything he could do food, lifestyle wise to get those numbers back down to “a healthy range”. Right?

So I'm going to walk you through what his lab results were and just help everyone kind of interpret what they meant for him. So I mentioned that his total cholesterol was 240. By many clinic standards, that would be considered elevated and put him at risk for developing heart disease. But he wanted to work on diet first before starting a medication. So that's kind of where we're at with that right now.

MELANIE: So great. And just to clarify, LDL stands for low density lipoprotein. And some refer to it as bad cholesterol, although as I mentioned earlier, it's just the patching material trying to protect those blood vessels. And although it is possible to have too much LDL, which means your body is having to patch a lot in some instances. Brandy, do you know what the breakdown of his other numbers were? Like what was his LDL?

BRANDY: So his LDL was what his doctor considered the at risk range. So it was 140. So just for your reference, you know, if you're looking at your own lab results at home, the typical range that you'll get at the clinic to assess your risk is if your LDL number is 100 or lower, you're in the no risk category. Once that number hits 100 to 159, 160, you're now at like low risk to medium risk. So my client was in that at risk range.

MELANIE: And you did give a little quote there with your ear bunnies, like a little quote with your fingers. At risk according to…

BRANDY: Yep. According to most clinics’ standards, right?

MELANIE: Good.

BRANDY: But we'll, we'll kind of dive into that a little deeper.

MELANIE: Yeah. Good.

BRANDY: Yep. And then once your number is 160 or higher, you're launched into this high risk category.

MELANIE: Yeah. And that's where people get afraid.

BRANDY: Yeah.

MELANIE: Justifiably. Right? And just to clarify, LDL stands for low density lipoprotein. And some refer to it as the bad cholesterol, although, as I mentioned earlier, it's patching material that could indicate that you're having some damage to the blood vessel wall.

And although it is possible to have too much LDL, we need to know about all the other numbers before being able to assess your actual risk of heart disease. So what was his HDL?

BRANDY: Yes. HDL. I'm glad you asked about that because to me, that's usually the very first number I look at.

MELANIE: Yeah.

BRANDY: Yeah. Because HDL is actually very protective for the heart. It's very, it's healthy. It's good for you. And just as a reminder, HDL stands for high density lipoprotein. also known as the good cholesterol. So this is the type of cholesterol that shuttles around through your blood vessels. It helps clear the harmful cholesterol, the bad cholesterol, out of the bloodstream. Then it takes it to the liver where it's either recycled or gets eliminated from the body.

And just for your reference, we want to see that HDL number a little higher. For women, we want to see that number 60 or above. For men, we want to see that number at least 50. So 50 or above is best. And my client's HDL was actually really great. So yeah, he had an HDL number of 80. So that was fantastic.

MELANIE: That's fantastic.

BRANDY: Yeah. So that number alone, that puts him in my eyes at a low risk category, low risk for developing any heart issues because of how protective it is for the heart.

MELANIE: It's the best news to deliver to a client ever.

BRANDY: Yes. Yes.

MELANIE: That sometimes your total cholesterol is popped up above that 200 number because of the good guys that are protecting you. So if you love math, a quick way to know how the numbers add up is to take your LDL, add it to your HDL, and then add on 20 percent of your triglycerides. That equals your total cholesterol. And that's it one of the first things I look at is triglyceride numbers.

High triglycerides increase risk for stroke & heart disease

BRANDY: Right. Yeah, that's another good measure of heart health. You know, just looking at the triglycerides all by themselves can give you some clues on how you're doing. It is a really important player when it comes to looking at that complete panel. Because triglycerides that are elevated, triglycerides that are very high can contribute to the development of stroke and heart disease. So when it comes to triglycerides, the lower, the better. And we really want to see that number less than 100, ideally, maybe less than 75.

MELANIE: I agree. I agree. And I have heard it said, I think it was Dr. Mark Hyman that said the biggest indicator of heart disease is your triglycerides being elevated.

BRANDY: Yep. Yep. It is a really strong independent predictor of heart issues. So…

MELANIE: And what raises triglycerides? Processed carbohydrates and sugar and alcohol. It sounds like you looked at the whole picture with him, of course. And to sum up, he had a mid-range LDL, but his doctor said it was a slight risk, but because of his good HDL cholesterol was so high and his triglycerides were pretty low at a hundred, we see that as actually a really healthy cholesterol panel.

BRANDY: Exactly.

MELANIE: So you gave him the good news.

BRANDY: I did. I did. I just kind of put him at ease and he, I mean, to see the, the look of relief on his face when we broke this all down and like the takeaway is you're at low risk. And other than the numbers, he had a lot of really great, like, lifestyle factors in his favor.

MELANIE: Yes.

BRANDY: So he was pretty active. He exercised pretty frequently. He had like a daily routine of like a three mile loop around his neighborhood, picked up some pickleball games. So he was on the move often. And we know that movement can help increase that HDL cholesterol. Movement helps increase the helpful cholesterol.

Food wise, he had a pretty clean diet too. He ate mostly real food, I'd say like 85, 90, 95 percent of the time. Only a few guilty pleasures. Maybe he went out to eat once or twice a month, the occasional trip to the ice cream shop with his grandkids, but it really wasn't habitual. Generally, he was eating good, natural, healthy fats, loved his butter, loved his guacamole, so there were a lot of avocados in the picture, nut butter.

And like I said, the guilty pleasures were just kind of one offs, like a few times a month, but it was not a daily ritual, by any means. And I think that's what helped keep his triglycerides nice and low.

MELANIE: Yeah. I would agree. And it's not like he had to be so strict. Well, one of the books, if listeners, if you're looking for a book that is wonderful, that breaks this down, recaps everything that we're saying, there's a book out there called The Great Cholesterol Myth, and it's by Jonny Bowden and Stephen Sinatra.

And it's an excellent book. It's an easy read. And it will break down all of these risk factors, your cholesterol panel, so that you feel like you have a conversation of education when you come to your doctor's office.

BRANDY: Yes. Yeah. You have to advocate for yourself. And having that information is so helpful.

What are some foods & beverages that elevate triglycerides?

MELANIE: Some clients’ triglycerides can be elevated when they're eating a lot of the sweet treats, the processed foods like pasta, bread, cereal, bagels, crackers, muffins, chips can really spike your triglycerides. Even if you feel like you're drinking a lot of kombucha, you know, there's some sugar involved there and that can be one of the things that spikes you. So just take a look at, what am I eating? Even if you don't feel like you're eating that much of these foods, it can really start having an impact, especially as we age.

BRANDY: Exactly. And I'm glad you brought up kombucha because I think, you know, it's one of those drinks that's marketed as a health beverage but can be a source of hidden sugar. So you have to be careful about beverages because what you're drinking can also spike your triglycerides, especially like soda; even juice, which is natural but still really high in sugar, energy drinks, those sweet coffee drinks.

MELANIE: Oh, the pumpkin pie lattes, and the caramel macchiatos.

BRANDY: Exactly.

MELANIE: They're not just a beverage.

BRANDY: It's candy in a cup, right?

MELANIE: It's candy in a cup.

BRANDY: And alcohol. We have to think about alcohol too. I don't think many people realize that there is a direct connection between alcohol and elevated triglycerides.

MELANIE: Even red wine.

BRANDY: Even red wine.

MELANIE: Yes. So a lot of, it came out that red wine was such a cardiac boost for health and I'm sorry it's not.

BRANDY: Right.

MELANIE: You would have to drink so much red wine to get enough of the resveratrol in order for it to be beneficial.

BRANDY: Yeah. Not worth it.

MELANIE: Not worth it.

BRANDY: Not worth the risk.

MELANIE: We have to stop that madness. So we're getting ready to go to our next break. You are listening to Dishing Up Nutrition. I'm Melanie. I'm a Licensed and Registered Dietitian. I'm here with Brandy Buro. She's also a Licensed and Registered Dietitian. Our topic is why is my LDL cholesterol high? Cholesterol is a complex subject and if you would like additional information after listening to our show, we've got some great articles, resources, podcasts on our website at weightandwellness.com. Brandy and I will be back with some more information.

BREAK

BRANDY: Welcome back to Dishing Up Nutrition. Our topic today is why is my LDL cholesterol so high? And one of our dietitians, Kristi Kalinsky, actually wrote a really great article titled “Understanding Cholesterol”. So that was published April 11th, 2023. If you want a little bit more information on this topic, I encourage you to check that article out. It has so much good information.

MELANIE: She did a fantastic job.

BRANDY: Yeah, she did a really great job. There's a lot of other resources linked within that article that you can use. So you can access that article on our website, weightandwellness.com. So just go to the website, in the search tab you can just type in “cholesterol” or “understanding cholesterol” and that article will pop right up. So, lots of good information there.

And if you're feeling like you would like a little support in your own health journey, you're taking a look at your cholesterol labs from your last physical, and you're wanting some help just to interpret those, and maybe come up with a meal plan that's going to help you get your numbers back on track, please give us a call. Set up an appointment with one of our dietitians or nutritionists.

MELANIE: All of us can do it.

BRANDY: Yeah. All of us are well equipped to handle this concern. Totally. It's one of the main reasons people come to visit us. So give us a call. It's 651-699-3438.

Schedule Nutrition Counseling

MELANIE: Once you set up that appointment and you have a plan, all the anxiety goes away. And I've seen clients that really take the plan and run with it. They turn their numbers around in three months.

BRANDY: Yeah. Definitely.

MELANIE: It's, it's magic.

BRANDY: Food is powerful.

More on determining risk of heart disease

MELANIE: Food is powerful. And you might be wondering, but Melanie and Brandy, what if my LDL number is high and my other numbers are also considered higher risk of heart disease? That's kind of scary if while we're breaking this down and that's how you're feeling.

Well, it's a great question. And I have another client example because this happened to one of my longtime clients this past year. She emailed me. She was concerned about her cholesterol lab results and was especially concerned about her elevated LDL, which was 160.

Now, as licensed practitioners, Brandy and I know to not jump to any conclusions when we see cholesterol numbers, especially only one, right? It's the picture. And that was considered a higher range. However, after looking at her whole lipid panel, I discovered that her HDL cholesterol was actually too low. It was 45. And remember for women, we like to see it 60 or higher. So this was a little bit of a red flag to me.

BRANDY: Yeah. So looking at the whole picture, there were some things to worry about. HDL was low, so that means you're not getting that protective factor, right?

MELANIE: Yeah.

BRANDY: But I'm guessing you also looked at her triglycerides.

MELANIE: Yeah. Yeah. That's one of the first things.

BRANDY: Yeah. Because when I think about triglycerides, remember, it is a pretty accurate predictor of your risk of developing heart complications. So I like to look at that outside of those other numbers and the foods and beverages that can elevate that: processed carbohydrates, added sugar, refined oils; that can give us some clues about what's going on in the diet.

BRANDY: Yeah, absolutely. It's a really great point, Brandy. We also had some, had to work on her triglycerides because they had creeped up to almost 200. So it's not the highest number I've ever seen, but definitely higher than we wanted. And a goal we give our clients at Nutritional Weight and Wellness is get your triglycerides under 100, but I prefer to see them 75 or less.

BRANDY: Yep.

MELANIE: High triglycerides are the big red flag because they increase your risk for stroke and heart attack; high blood sugars, leading to prediabetes or type 2 diabetes are also the concern there. So we worked on that total picture and I'm pleased to report that after three months, she surprised her physician and he said, I don't know what you're doing, but keep doing it because we had corrected course there.

BRANDY: Awesome. What a great feeling that must have been for her.

MELANIE: Yeah. And me. I mean, it was just so great when you see the joy and the relief in your client's face, it's the best job in the world.

BRANDY: So how did you do it? What did you recommend for her?

MELANIE: Well, we got her blood sugars under control, so she was eating actually a lot more fruit and a lot more, it was gluten free, but it was pasta than really was recommended. So we scaled back on some of that carbohydrates, especially the ones that were processed, pasta, crackers with cheese, not because of the cheese but because of the crackers, and the wine habit, two to three glasses in the evenings.

And we add in a few key supplements that were appropriate for her and that's what turned it around, made sure she was getting enough protein and healthy fats to balance her blood sugar. Yeah. She was kind of surprised because it wasn't a huge change in her diet, but it was a huge change in her numbers.

BRANDY: Right.

MELANIE: So, it wasn't difficult for her. She felt it very easy and she said, I can do this the rest of my life. I'm like, great.

BRANDY: I love to hear that confidence. That's a really good point. A couple glasses of wine could easily spike up those triglycerides.

MELANIE: It pops it up. It does. And her doctor had talked about going on a cholesterol lowering medication, which she did not want to do just because there are side effects to these things. And she wanted to explore those other options. And that's what we did. Three months it was improved, six months dramatically improved.

She had changed some of the bad habits that she had acquired during the pandemic and maybe changing a few things, a little less chocolate with her red wine and it all had added up.

BRANDY: It's easy for some of those habits or like the occasional treat to become habit. What's the habitual behaviors that are going to contribute to those numbers that you see? It's not the one off occasions where you order pizza and have a couple glasses of wine, like once a couple months or something like that.

MELANIE: Exactly. I mean, because life.

BRANDY: Because, because life, but it's not those one offs that are going to cause the issues.

MELANIE: It's the pattern. It's the habit. And you know, 90, 10, 90 percent of the time, do it right. And she called herself a stress eater. And let's be honest, it's been a stressful few years for most of us. And those were her go to comfort sweets.

Another thing that she was doing, which I remember was a big bowl of cereal and milk. You know, that was our childhood comfort food. So we changed that around and got rid of some processed bad oils, processed white flour, and it all had added up. So…

BRANDY: Yeah. And I think a lot of old habits crept back in around the pandemic. You know, we're looking for that comfort and…

MELANIE: It's an easy thing, right?

BRANDY: Yeah.

Overviewing advanced testing that can be done to further determine risk

MELANIE: So, Brandy, you hosted a fantastic “Ask a Nutritionist” segment earlier this year called “Managing Cholesterol”. It was wonderful. I encourage everyone to listen to it. I consider you an expert in this area now after seeing that. And can you explain to listeners the difference between LDL and the tests that are, the different types of LDL and then tests that are available?

BRANDY: Absolutely. Absolutely. Yeah, and if anyone wants to check out that episode, that was part of our midweek segment called “Ask a Nutritionist”. That came out March 9th, 2023. So it's a pretty quick listen. They're pretty short, but you can get that from our website, weightandwellness.com, or wherever you get your podcasts; Spotify, Stitcher.

But just a couple of things that I talked about in that segment were about some more advanced tests that you can ask for that actually have research showing a better predictor of what your risk of developing heart disease is. You can figure out what types of LDL particles you have.

And you can also figure out how many LDL particles you have because a lot of the research that we're finding, not just myself but other dietitians in our clinic, we're finding that knowing how many LDL particles you have will actually give you a better prediction of your risk of heart disease. I really like the analogy of thinking about those LDL particles as, like, cars on the highway. Traffic, right?

MELANIE: Yeah.

BRANDY: So the more cars on the highway, the more congested the traffic is, the more likely it is that you're going to get into an accident.

MELANIE: That's brilliant. I love that. I'm using that.

BRANDY: You can use it. I borrowed it from someone else, but it works, right? So we really want the number of LDL particles to be lower. The lower the number, the less likely it is you're going to get into an accident. The less likely it's going to cause damage. So these advanced tests weren't always available, but they are available now.

There are things that you can request at your next physical, especially if your standard lipid panel comes back and there's some red flags and you want to investigate further. So, not just for high risk patients anymore.

MELANIE: And the name of that test is…?

BRANDY: Right. That test, that specific test is called the NMR Lipo Profile Test. So that's going to tell you how many LDL particles you have and the type of LDL particles you have.

MELANIE: That's great. So listeners, I hope we have made you feel a little more confident in the numbers that you're reading when you look at your lipid panel. It's an easy fix when you are concerned about your cholesterol numbers. If you need a professional, we're here for you at Nutritional Weight and Wellness.

But we always encourage real food, eating in balance, balance your blood sugar, and avoid those processed carbohydrates, too much sugar, too much alcohol, and focus on vegetables, a good amount of animal protein. Don't be afraid of that cholesterol, and those healthy fats that we talked about.

BRANDY: Exactly.

MELANIE: Yeah. And just keeping your triglyceride numbers low, your HDL up, and your LDL, you know, then you can evaluate what's going on there. And I really encourage you to go to our website, listen to Brandy, break down the particles for you, the two different types, which are…

BRANDY: Yeah. There's the type A or the type B. So that episode we'll dive into what that all means.

MELANIE: Yeah. And I think that would be really helpful for our listeners. So, Brandy, could you break down for our listeners the LDL types?

BRANDY: Definitely. Right. So that, that test that I was talking about, that NMR profile test, that is going to give you information about the type of LDL you have, the pattern of LDL you have. So there's two main patterns that you can have.

So you can have pattern A, and that is the less harmful pattern. That means the LDL particles you have, most of them are large and fluffy, buoyant. They're less likely to become damaged, less likely to cause damage. Pattern B is the more damaging pattern of LDL. So that's going to be smaller, more dense particles, more likely to get lodged into those blood vessels and cause that, that plaque buildup.

MELANIE: The scarring and damage.

BRANDY: Yeah. Yes, exactly. If you were to have a lipid panel where there is some concern, maybe your LDL is a little more elevated and you just want to, for peace of mind, understand those numbers better, you can ask for that NMR profile test to figure out, do I have type A, which is actually not really a big concern, or is it type B?

MELANIE: Sometimes it just sets your mind at ease if you're able to get that test and I know that mainstream physicians are doing it more and more. You can also pay out of pocket at certain clinics. Labs will do it for you. You can order it for yourself if you're really concerned. I also tell clients if they're super concerned that they can also do a calcium score.

BRANDY: Oh, that's a good suggestion.

MELANIE: And have that test. And I had a client who was very concerned. Her calcium score was zero. So she was in great shape. But sometimes when we have the data in front of us, it puts us at ease.

BRANDY: Exactly. And sometimes it's what you need to put your doctor at ease, too.

MELANIE: Oh, really good point. Or get them from nagging you to get on a medication when perhaps you don't really need one.

BRANDY: Exactly.

MELANIE: But our goal at Nutritional Weight and Wellness is to help each and every person experience better health through eating real food. It's a simple yet powerful message. Eating real food is life changing. Thank you for listening to Brandy and I and have a wonderful day.