Managing High Cholesterol with Lifestyle Approaches – Sheila’s Quest

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Angela G. Gentile, MSW, RSW

My good friend Sheila, 55, recently shared with me her story about high cholesterol and how she has made a very concerted effort to change her lifestyle in order to avoid taking “statin” drugs to help keep her cholesterol counts at a healthy level. High cholesterol, of the “bad” kind (LDL), can cause an increased risk for a heart attack or stroke. I am happy to say Sheila has been very successful in getting on top of her cholesterol levels and she would like to share her story here in hopes of perhaps helping others.

41% of Canadians have hazardous blood cholesterol levels, so this is not an uncommon problem. Some only find out after their first heart attack. Research indicates that there is a fairly high percentage of adults in Canada who are unaware of their unhealthy blood cholesterol levels (also known as dyslipidemia). The older we get, the higher our risk for unhealthy cholesterol levels.

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According to Statistics Canada’s “Canadian Health Measures Survey” released in 2010, 47% of adults between the ages of 40 and 59 and 54% of those aged 60 to 79 had high levels of total cholesterol.

Source: https://www.cbc.ca/news/technology/cholesterol-keeping-your-levels-in-check-1.880731

At around age 52, Sheila learned she had high cholesterol. Her doctor at the time told her her total count had gone from 3.2 to 6.8 and tended to minimize it because her “good cholesterol was high so don’t worry.” The doctor gave her no strategies at this point. Sheila told me she was worried because her mother had had a few TIAs (mini-strokes) later in life and her grandmother (her mom’s mom) had died of a stroke. As she talked to her siblings, she found out 3 of 5 were on statins (a commonly prescribed medication for high cholesterol – such as Lipitor or Crestor). Sheila did not want to go on medications as she knew she would probably have to be on them for life. This was a lifestyle change she prefers to avoid. She preferred to take a “change in lifestyle” approach to help manage her health. At first, she didn’t acknowledge the severity of this condition (and her doctor didn’t either). She occasionally dieted to lose a few pounds but never really connected it to her overall health. She would lose some weight, then soon after, gain the weight back.  She was a member of Weight Watchers (WW), but the dieting program which focuses on counting points didn’t really stick with her at the time.

A couple of years later, Sheila’s doctor was reducing the number of patients in her practice, so she had to find a new doctor. In September 2018 she saw her new doctor who ordered blood work including a lipid profile and did a blood pressure check. Sheila was soon called back for a follow-up appointment to discuss her high cholesterol (now at 7.6 total cholesterol) and high blood pressure (her previous doctor was aware of these issues, but did not do anything about it). Sheila told her new doctor that she didn’t want to go on medications and asked for an alternative way to manage these conditions. The new doctor replied, “Start with weight loss.” Her doctor also instructed her to monitor her blood pressure for three months and come back to discuss the results.

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Sheila started back on WW and started taking her blood pressure regularly. She increased her physical activity and increased her time walking the track at work from 20 minutes daily to 30 minutes daily. She went back to her doctor every three months to show her where she was at with her blood pressure. As her weight loss increased, her blood pressure progressively decreased. She was seeing progress. The doctor also said she wasn’t able to take her blood test to check her cholesterol more than once a year so they would check for that in the fall.

One year later, in September 2019, Sheila was happy to report she had lost 25 pounds. Her blood pressure was down to 130/90 and the doctor said there was still room for it to go down but was pleased with her progress. After increasing exercise and losing weight, the blood tests showed that Sheila’s total cholesterol was down to 7.5, which was down by only measly 0.1. Sheila was disheartened by this as she felt she had been working so hard. Her LDL was at 5.0, whereas the normal target is under 3.5. Sheila wanted to know if there was anything more she could do to reduce the numbers (other than going on medication). The doctor asked her if she wanted to go to a Lipid Clinic and to see a dietician. Sheila agreed to both.

Sheila was disheartened as all the efforts of her lifestyle changes of losing weight and exercising did not reflect in her test results. She was feeling discouraged. Determined to turn over every stone before going on statins, she went to see the dietician.

The dietician said that doctors often look at the “total” cholesterol and they need to look at the three groups – LDL, HDL, and Triglycerides. Sheila’s triglycerides and HDL were excellent and the dietician asked Sheila about her diet. She said Sheila’s diet was very healthy, which included low sugar, low white bread, limited alcohol, low fat, lots of fruits and vegetables, and whole foods. The dietician was also pleased with Sheila’s level of physical activity. The dietician praised Sheila for her weight loss and said that although the good cholesterol (HDL) and triglycerides were good, having a high LDL could mean that she has “familial hypercholesterolemia” (FH) which means she could have inherited the gene for high cholesterol.

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To help reduce Sheila’s bad cholesterol, the dietician recommended Sheila consider adding the following to her lifestyle approach to managing her cholesterol:

  • Follow the Meditteranean diet.
  • Eat three meals a week without any animal products.
  • Make her own salad dressing because sometimes store-bought dressings contain oils that contain saturated or trans fats.
  • Eat more nuts in her diet (on salads, in yogurt). This includes almonds, hemp, flaxseed or chia.
  • Increase cardio exercise by hitting her “target heart rate” for 15 minutes twice-weekly (aka High-Intensity Interval Training or HIIT).

Sheila learned that her practice of “counting steps” is good, however, it is individual for each person. Sheila’s job keeps her on her feet and it is not uncommon for her to reach 10,000 steps a day. However, for heart health, it is important to add in some cardio activity. When the blood pumps through the arteries due to exertion, this creates a “blood-plumbing” effect which can help clean out the arteries, leaving less opportunity for clogs.

Surprisingly, the dietician told Sheila it’s okay to eat eggs, they are not the culprit for causing high cholesterol. Also, she notes that eating loads of refined sugar is the new smoking.

Sheila left the dietician’s office feeling very happy and encouraged, considering two weeks prior she was feeling so defeated. She is well-aware that for some people, no matter what they do, they may still need to go on medications. She is planning on going to the Lipid Clinic as well, so as she says, “Stay tuned.”

For reference, here are what the lipid profile targets are for a 55-year-old female after fasting for 12 hours (may be different for gender and age):

Cholesterol (Total): <5.0 mmol/L

Triglycerides (fasting): <1.7 mmol/L

HDL Cholesterol: >1.3 mmol/L

LDL Cholesterol: <3.5 mmol/L

Non-HDL Cholesterol: <4.3 mmol/L

For more information on how to manage high blood cholesterol, check out this article called High Cholesterol from the Mayo Clinic.

Check out the Heart and Stroke Association’s booklet on How to Manage Your Cholesterol.

I strongly urge you to get your blood cholesterol levels checked (“Lipid Profile”) and to work with your healthcare team to help reduce your risk of heart disease. 

 

 

 

 

 

 

 

 

 

 

 

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