How concerned should I be about my cholesterol levels?

April 30, 2021 1:39 AM

I recently had a medical exam, and one of the things noted in the results was that my cholesterol levels were high. Specifically, my LDL levels are borderline high, at 3.94 mmo/L (152 mg/dL). I get that I should try to reduce my levels, but in the scheme of things, should I be very worried, or is this not that uncommon?

For more context, I'll be turning 39 this year, and my HDL levels are good: 1.27 mmo/L. Last year, my LDL was 2.76, which was not that great but still ok, and my HDL was 0.98. 2020 was kind of a crazy year, so I'm guessing my unhealthy diet and lifestyle during that period probably affected things.

Suggestions for lowering my cholesterol are welcome too. My current plan (which was what I've been meaning to do anyway) is to start eating less meat, and exercise more.

posted by destrius to Health & Fitness (12 answers total)

As I understand it, it's the ratio of LDL/HDL that's the most important factor, and anything over 5.0 is bad, while under 2.0-5.0 is good and <2>
Changing your dietary cholesterol (e.g. eating less meat) is generally not very effective, while exercise does often help.

Disclaimer: I am not a doctor, I just read a lot about cholesterol and diet.
posted by Umami Dearest at 2:08 AM on April 30, 2021

FWIW, my overall cholesterol was recently coming in at 5.5 (supposed to be below 5) and the consultant gastroenterologist I was seeing for something else effectively said in passing: "Wellll it's a bit on the high side, but not a huge deal" and didn't tell me I should be cutting down or anything (at this stage I'd not had LDL and HDL measured separately).

I'm not able to exercise at the moment, but decided to cut out butter* and what little red meat I was eating, and also started to work on losing a few pounds for other health reasons. About 3 weeks later my overall cholesterol was down to 4.8 (with my HDL similar to yours and LDL a little lower than yours). I was surprised and gratified that it had dropped already, though tbh my body's doing a lot of weird shit at the moment, so who knows, it could yet go back up again...

My GP stuck all my details, including cholesterol, blood pressure, height, weight etc., into some kind of risk calculator and came out that I had about a 3% chance of having a heart attack or stroke in the next 10 years, then said: "Which is about as good as it gets in these parts" ie. they have to enter your postcode as a very blunt attempt at accounting for lifestyle factors, and my postcode is at the rougher end of the deprivation scale, so that was actually a pretty decent score.

So my take is that being slightly above recommended levels isn't going to make you drop down dead, or even necessarily worry doctors if other things about you are healthy, but if you know about it you might as well tweak some stuff to tilt the line graph back down, rather than find out in 10 years' time that you've got a problem.

*One weird little trick: Stick some olive oil in a tupperware container, put it in the freezer to solidify, pull it out and stick it in the fridge - bingo, spreadable! It's pretty dense because there's no air whipped into it like a lot of spreads so you don't wanna go crazy with it, but it's made giving up butter on toast easier. Just don't leave it out on the counter for too long cos it'll be back to oil in no time. I've also started increasing the proportions of veg and pulses in my meals, looking for veg-heavy recipes that use herbs and spices well for flavouring rather than cheese and fat, treating cheese as a garnish rather than a main ingredient etc.
posted by penguin pie at 2:51 AM on April 30, 2021 [2 favorites]

Your current plan seems like a good place to start. I’d make your goals more concrete.... only eat meat once a week, for example - walk five days a week. That way your not just guessing at whether you’re hitting your goals.
posted by backwards guitar at 5:30 AM on April 30, 2021 [1 favorite]

At 42 my cholesterol levels are higher than yours, and there's a good chance it's hereditary. I'm mostly vegetarian, dairy-free, in good shape, etc., and it hasn't really budged for years. We've decided that if it's still high next checkup it's probably statin time.
posted by aspersioncast at 6:03 AM on April 30, 2021 [2 favorites]

Most people can probably lower their cholesterol through diet, though how extreme that diet needs to be is very individual. I used to have a total cholesterol around 200. I became vegan, and that got it to around 120 (only animal products have cholesterol). However, my triglycerides remained high and my HDL too low until I cut out processed foods, including oil, following Joel Fuhrman's Eat to Live diet (I get fat from nuts, seeds, and avocados). After I'd been on that diet for a while, those both normalized. It also got my blood pressure down to normal - a vegan diet with some processed foods had my systolic down to around 135 from the 160s, no longer at a level that requires medication, but still on the high side. So my body seems to require a diet that will seem extreme to most people to get the results I want. (I prefer the extreme diet to being on medication - obviously, not everyone feels that way.)

Cutting down on meat and/or eggs might be enough for you, but you'll need to try it to find out. (You may have heard that eggs don't raise cholesterol - that's according to studies funded by the egg industry, which are problematic (Washington Post article).)
posted by FencingGal at 6:23 AM on April 30, 2021 [2 favorites]

This calculator will give you a specific estimated risk, which I think will be reassuring.
posted by Mr.Know-it-some at 7:02 AM on April 30, 2021 [1 favorite]

Here's "one odd trick" relating to cholesterol.

Unfiltered coffee or coffee made through coarse filters (reusable metal filters, french press) contain lipids that elevate LDLs. These are mostly removed when paper filters are used.

YMMV depending on your coffee consumption and preferred brewing method.
posted by jclarkin at 8:19 AM on April 30, 2021 [6 favorites]

Yeah, but they're delicious lipids in that French press coffee.

Anyway. My cholesterol was at the "borderline, you should eat more fish" level for a couple years, the last of which also involved me taking a fish oil capsule every morning. My HDL and LDL didn't budge from any attempt to exercise more or change my diet, even with the fish oil (my triglycerides did improve, but on their own that wasn't enough). My PCP eventually put me on a statin and my numbers have been "great" ever since. Just make sure you're checking in with your doctor on a regular basis, and they'll keep an eye on it and tell you when it's time for a statin.
posted by fedward at 9:54 AM on April 30, 2021

My LDL cholesterol dropped from 120 mg to 115 mg over two years, during which I went from being vegetarian to eating meat, and also gaining about 5 lbs and exercising slightly less. I was very surprised by this result (my other lab numbers also improved too). I asked the doctor, and she mentioned that stress can have an influence. (I had a very stressful relationship end between doctors visits). So, this is a single piece of anecdata, but don't rule out the mess of 2020 affecting your counts somewhat.
posted by Sparky Buttons at 10:32 AM on April 30, 2021 [1 favorite]

I really like the Mayo Clinic's Statin Decision Aid, not so much because you need a statin but because it lets you plug in a bunch of factors like weight, blood pressure, etc and get an individualized risk score, and then play around with various interventions. In general for young people (39 is young for cholesterol purposes; you'll have to use age 40 for the model) reducing cholesterol doesn't actually lower your risk of heart attack/stroke by all that much because it's already low. (That doesn't mean you shouldn't adopt healthy lifestyle practices or that you won't need to do something about it later in life when your risk is higher just due to age).
posted by The Elusive Architeuthis at 12:32 PM on April 30, 2021 [3 favorites]

Response by poster: Thanks for all the replies everybody! For now I'll try to make some small but concrete changes, see if the results get better, and not stress too much about it in the meantime.
posted by destrius at 8:22 AM on May 1, 2021

If you like it, add oatmeal to your diet. I think that's usually high on the cholesterol-lowering list of foods.
posted by swheatie at 2:08 PM on May 2, 2021