Higher cholesterol...should I be concerned?

[Paul Gambill]

After about 2 months (one Whole30, followed by a consistent diet of Whole30-approved foods, but with added alcohol (3-5/week) and occasional rice) of this diet change, I went in to see my doctor for blood testing to see where I was at. Turns out my cholesterol is extremely high now, and I wanted to review with you folks here a typical day in my diet, and see if you have any suggestions for what I should do next. Typical diet day below, and I've attached a screenshot of test results from Nov 2011 (mostly vegetarian diet high in grains, legumes, and vegetables) and May 2013 for comparison:

Breakfast

4-5 eggs

3 pieces chicken sausage

half bell pepper

handful snap peas

handful baby carrots

banana

Lunch

roasted chicken

roasted vegetables (mushrooms, peppers, zucchini, onion)

Dinner

grass fed steak or ground beef

broccoli

asparagus

glass of wine or beer

Test results comparison: http://i.imgur.com/FS3LIno.png

[Renee Lee]

Paul, was your LDL calculated or directly measured? Your food looks good as do your other values (tris, and HDL), so I wonder if it's a calculated value. The formula to calculate the LDL value isn't super accurate when your triglycerides are low. It over-inflates the value. I'd recommend a followup with either a directly measured LDL value or an LDL-P test (that's particle number).

Here's a quick description of what and why LDL-p is a more valuable test. http://www.docsopinion.com/health-and-nutrition/lipids/ldl-p/

[Paul Gambill]

Renee, I asked my doctor and she explained that it was calculated. She also included this information about my Framingham 10-year heart disease risk:

The LDL is a calculated value. Some people argue that a direct measurement is better, this is done through different test such as VAP cholesterol screening, but this is not covered by insurance. In my experience when someone's calculated LDL has been high, their measured LDL has also been high, but there is some variation in the numbers. Given your good high HDL, the ratio of your good and bad cholesterol is good. And given your other "risk factors" your current risk for heart disease is low (here is how this is calculated from the Framingham Heart Health Study)

Framingham 10-year CHD Risk Score: 1% (1 Total Points)

Values used to calculate score:

Age: 24 years -- Points: -9

Total Cholesterol: 282 mg/dL -- Points: 11

HDL Cholesterol: 72 mg/dL -- Points: -1

Systolic BP (untreated): 118 mmHg -- Points: 0

The patient is not a smoker. -- Points: 0

The patient has not been diagnosed with diabetes. -- Points: 0

So at this point in your life your higher total cholesterol and LDL do not pose a significant risk. However if you were 65 with the same cholesterol and blood pressure, your risk goes from 1% in 10 years of having a heart event to 10% risk in 10 years. I hope this helps you understand how I look at cholesterol and think about risk. As with many things in medicine, there will always be conflicting opinions.