Filter my diagnosis!
November 3, 2010 4:56 PM   Subscribe

Is it possible for your cholesterol levels to be transiently elevated, and if not, what should I do about mine?

I know there are a lot of similar health questions.

Is it possible for your cholesterol levels to be transiently elevated? I visited my doctor for a routine physical and bloodwork right after a week with a lot of family visits during which we dined out at least five times in seven days. One of the dinners was extremely decadent (seven courses, expensive) and most of the others were not particularly light. I also baked two pound-cake like poppy-seed cakes, which everyone ate.

I had my cholesterol tested right after this course of dining. Total was 232; normal is stated to be less than 200. My HDL was acceptable, LDL 140; normal LDL less than 100-120. The doctor prescribes a low-fat diet.

I am not overweight (5'2", 108 pounds) and I am in reasonable physical shape. I can walk a mile in 15 minutes and climb 96 steps (long escalator) without stopping. I do not have other health problems except for slight hypothyroidism, diagnosed by the same doctor (I had not noticed anything), for which I take Synthroid. I also take an antidepressant (tricyclic). I am 39 years old. I am not keen on taking more drugs.

I think that I eat pretty healthily, aside from the restaurant week, which started to seem like food torture (Uncle: "Do you want to go to Starbucks? Do you want a cappucino, mochacino, double latte?" Me: "NO, PLEASE! BLACK COFFEE!").

I thought that I was doing OK because I don't gain weight easily (see thread about "What thin people eat"). Now I find that the fat is floating around inside my arteries, presumably. But I still don't eat deep-fried things, most cheese, cream, dairy, ice cream, hamburgers, fast food, etc. It is possible that I have let my diet slip, and I will try to cut out what I can. But I'm afraid that only the extremism of Dean Ornish or the raw-foodists will reduce my levels.

Except for the food-torture week, I already don't eat out a lot; I do the cooking in my family and I watch what goes in (no Paula Deen-type whole sticks of butter in one dish).

What I will really, really miss is chocolate.

I am not happy with this diagnosis, in part because I had a borderline eating disorder in college, weighed 91 pounds at one point and usually less than 100, and was persecuted (so I felt) by the campus psychiatrists and doctors. (It was my fault; I had tried out for track. There were other anorectic-looking women at the school, but nobody bothered them if they didn't go out for sports.) It was Me vs. The World back then, which was good for my studies (I sublimated) but not good for personal relationships.

Now I feel that I don't want this state of mind, which bordered on paranoia, to come back. I do not want the Me vs. The World mentality to return especially when I am trying to hold on to a job where there are many overweight people. I don't want to cause conflict at home either (in the anorectic I WILL NOT EAT THIS mode).
posted by bad grammar to Health & Fitness (15 answers total) 3 users marked this as a favorite
One thing that can transiently increase blood cholesterol is an unusually stressful event. I remember when a friend of mine was about to draw blood from a rat. An obnoxious coworker entered the lab behind her back, and suddenly made a loud exclamation, clapping his hands. She jumped, the rat jumped, she dropped the rat, and had to chase the rat all over the lab before she could catch it and draw its blood. Its serum cholesterol level was far higher that day than it ever was before or afterwards, for that particular rat.

Taking an inadequate dosage of thyroxine (your Synthroid) can also raise serum cholesterol levels significantly. Hypothyroidism is a common cause of high cholesterol. Is there any chance your dosage is not sufficient? It can take several months to see the result of a dosage correction on your cholesterol levels.

There are things that can transiently raise your cholesterol levels. Whether your current situation is transient is impossible to tell unless you have the tests repeated a few times. As a scientist, I don't ever trust a single data point. I've seen too many outliers that were never repeated again. That doesn't mean you'd be safe in ignoring this one. If I were in your situation, I'd try eating normally for a couple of months and have the test repeated. I'd also want to make sure my TSH levels were no higher than 1.0 mIU/L, since I personally suffer badly from hypothyroidism at higher TSH levels, even though this is well below the upper end of the "normal" range for TSH levels.
posted by Ery at 5:17 PM on November 3, 2010

Yes, it is possible to have transiently elevated cholesterol. But why not test it again, once you are on a good diet? Get on a decent diet, stick to it for 8 weeks or so, then re-test. That's the only way you'll find out.

In general, you don't want your Total Cholesterol to be too high (much over 200), but it's also very important to know your HDL to LDL ratio. If your HDL is high enough it can compensate (to a degree) for LDL (as long as your TC is not too high). In your situation, you want to lower your LDL, and if your HDL is not high enough to give you a good ratio, perhaps elevate your HDL. To elevate HDL, exercise (especially aerobic) - for males a glass of wine a day (not females though - the cancer risk outweighs the CV benefits). To lower your LDL - cut out as much saturated fat as possible (including stearic SF in chocolate - even though SSF does not directly elevate cholesterol, in studies, it still is associated with worse CV outcomes). Cut back on carbs, especially simple sugars. Dramatically up your soluble fiber intake (though do so gradually over a period of time). Here is also a useful link wrt. diet.

And definitely get retested in 8 weeks or so, once you've cleaned up your diet, to see if your lifestyle changes are working.
posted by VikingSword at 5:22 PM on November 3, 2010

Anecdata here: My cholesterol gets tracked pretty frequently because I donate blood every eight weeks and that's part of the information that's provided on their website post-donation. My total cholesterol varies by 20 or more points from donation to donation, depending largely on whether I've had a steak dinner a few days prior or not. (I am also hypothyroid, BTW, but I don't think that has any real bearing here. At least for me, my total cholesterol, HDL, and LDL didn't vary much pre- to post-hypothyroid treatment.)

So yes, cholesterol readings vary over time depending on what you've been doing (as you had suspected). The real issue is what your HDL is, for a few reasons. First, it is much less variable. Second, there is a world of difference between HDL and LDL, both of which contribute to your total cholesterol. My doctor considers the ratio between the two and proclaims my total cholesterol of slightly more than 200 "something to watch" but not treat.
posted by DrGail at 5:22 PM on November 3, 2010

Track everything that goes into your body for 60 days. Until you actually know (and not just think) that your diet is good, it is pure speculation. I went through this earlier this year. In my case, I was averaging about 50% of my weekly RDA for cholesterol. So I ramped up the exercise a bit.

There can also be a fairly strong genetic factor for cholesterol. You can't do much about your DNA.
posted by COD at 5:24 PM on November 3, 2010

Is your coffee filtered? Coffee can raise your cholesterol, but using a filter takes out the cholesterol-raising chemicals called diterpenes.
posted by Knowyournuts at 5:29 PM on November 3, 2010 [1 favorite]

I'm very interested in this question because I also had high cholesterol (don't remember the levels but it was high overall cholesterol as well as high LDL and high HDL which the doctor thought odd). And like you, I don't have a lot of other risk factors for heart attacks or strokes.

When I went to the doctor's to discuss my results, I figured I'd be lectured about changing my diet and losing weight so I started a food journal. I walked in and the nurse realized that I don't have any weight to lose, I was eating well and exercising. She just shrugged and said I should get retested in a couple years and keep doing what I was doing.

Anyway, I've decided not to worry about it. According to what I remember from the doctor's: cholesterol in combination with other factors (age, activity level, sex, weight) is linked to heart attacks and strokes. But cholesterol alone doesn't cause a huge increase in risk.
posted by hydrobatidae at 5:44 PM on November 3, 2010

Response by poster: Thank you for your quick suggestions!

I will try the dietary changes.

I do drink a lot of coffee, 2-3 cups a day. The pot has a metal filter. I can try cutting back, but I need to stay alert at work. I don't want to raise the aspartame-is-poison types, but I also drink a lot of diet soda (never full-calorie soda).

On the subject of food neuroticism, I have made clear that I don't want to go there again. I don't want to end up one of those people who spend all their time reading and daydreaming about cookbooks with traditional high-fat recipes that they would never cook and eat. Maybe I have attempted to relax my diet a bit in a mentally healthy way and now I feel had.

On the subject of stress, we do not get on very well with one of the relatives who visited during the "restaurant week." There were political arguments. I and my immediate family are liberal Democrats. The relative is a stereotype Republican (elderly, well-to-do, retired, investments). He is something of a know-it-all, but also kindly, which made the conflict worse for me. I don't know if three days of suppressed annoyance can actually raise your levels. ;)

My workplace is also fairly stressful, though I'm insulated from the worst of it. I've been on the job market for a "better" job since July and getting nowhere yet, and I've been trying not to feel the pain and fear.
posted by bad grammar at 5:48 PM on November 3, 2010

Switch to paper filters for the coffee.
posted by elsietheeel at 6:06 PM on November 3, 2010

Cholesterol is of interest not in it's own right but rather as an indicator of possible calcification in the arteries. My cholesterol was high this last physical, so my doc suggested I get a CT scan to look for arterial plaque. There was none, so my doc didn't think medication was appropriate. Sure, it would bring the number down, but there's no point in treating the number - instead he would treat if I had the plaque, cause trays directly linked to bad outcomes. I say this just to suggest that you may want to look deeper than just the cholesterol numbers if you're worried about health risks.
posted by jasper411 at 6:25 PM on November 3, 2010

You don't have to do anything extreme in terms of diet (e.g., raw foods/Ornish) if you don't want to. Like an above poster suggested, track what you eat and try to cut out the "bad" fats. Replace them with "good" fats, like in oily fish. Eat oatmeal or Cheerios. Increase your fiber intake. You don't have to give up chocolate. You don't have to obsess about this, and you should really be aware of your behaviors/thoughts and whether you start slipping into your old disordered way of thinking about food. It's great that's already on your radar.

Have you had high cholesterol readings in the past? It's entirely possible that to get the good numbers you will have to take another medicine, because for some people it really doesn't matter how well they eat, their liver is just gonna make as much cholesterol as it wants.

If you try diet and exercise and your numbers don't budge, well.... I had similar cholesterol readings several years ago, for a few consecutive readings, so the doctor put me on simvastatin (generic Zocor). I cried, being put on a new medicine that I knew was probably not just a temporary thing. In one month, my levels went down to almost completely normal. After a year, they decreased my dose and I still have low LDL and high HDL. I also don't have any side effects from the drug, and it's pretty cheap, plus they keep finding new good things about statins...
posted by eldiem at 6:27 PM on November 3, 2010 [1 favorite]

Please do not worry about cholesterol and your diet based on a single test result, and perhaps even a consistent series of test results. There is convincing evidence that the conventional wisdom -- lowering blood cholesterol through diet and/or drugs will reduce heart disease -- is incorrect.

Admittedly I am biased, because a family member has suffered serious impairment that I believe was a side effect of long-term statin use.

Food for thought:
The Great Cholesterol Con
The Cholesterol Myths
Duane Graveline, MD, MPH
posted by Snerd at 7:13 PM on November 3, 2010 [1 favorite]

I am 32 and in decent shape; I can run 5K and I eat a mostly vegetarian diet. I have high cholesterol -- actually, it was much higher than yours (from what I understand, they don't call your total "officially" high unless it's over 240, and they don't call LDL high unless it's over 160). So I wouldn't panic if I were you, but if you do want to bring it down, here's what worked for me:

I managed to bring it down by 50 points (25 points of LDL) over four months, but I did it through basically trying to get my saturated fats as close to zero as I possibly could. (Realistically, I was aiming for 10g/day.) That meant no full-fat dairy at all, no butter, no chocolate, no coconut, and no snack foods with any saturated fat in them. (I figured that I'd save any saturated fat intake for meals where it was unavoidable.) I also ate oat bran for breakfast and took fish oil supplements.

I thought I was eating pretty well before, but clearly eliminating those things -- especially butter and chocolate -- made a huge difference. I think the key was that I was really strict about it -- I'm not sure how critical it was to be so strict, and I'm probably going to relax it a bit going forward, but that's what worked for me.
posted by cider at 7:13 PM on November 3, 2010

Can you request a lipoprotein profile? My understanding (mostly from Good Calories, Bad Calories by Gary Taubes - an incredibly eye-opening book, especially around the science of cholesterol.) is that recent studies show you really only need to worry about your LDL level if it's primarily made up of the small dense type of LDL. The larger, fluffy particles have little correlation to heart disease and since the standard cholesterol test can't tell the difference, it's important to find out which kind you have before you make any dietary changes. IANAD, but as long as your HDL is high, your triglycerides are low, and your LDL is fluffy, you should be just fine.
posted by platinum at 7:35 PM on November 3, 2010

I think it would be better to get retested after a few weeks of your normal diet, in case the family food fest is the culprit. If it's still bad, then try to eat healthier and retest. (I give blood regularly and have them check my cholesterol, though, if you don't have an easy/cheap way to keep getting tested, this might not be a good idea.) FWIW, my cholesterol is never high, but it's lower when I am on a low carb diet. My husband has had the same results. (His cholesterol was about 240 a few years ago, I made him go on a low carb diet with me, it was 170 a month later.) I am perfectly happy with sugar free chocolate, though.
posted by artychoke at 8:49 PM on November 3, 2010

3rding paper filters - I dropped from a total cholesterol of 165 to 145 just by swapping the gold-foil filter out for paper. Here's Science Daily on some of the research.
posted by Orb2069 at 6:29 PM on November 4, 2010

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