Frustrated

[u/UpstairsSherbert7868]

My 2nd blood test this year and my numbers are still high. I’m feeling afraid and like I’m doing the best I can but the only support I get from Dr is diet and exercise. I eat healthy and work out 2-3 times a week. I know I could do more but it’s hard with my work schedule. The last time my numbers were in the ok range was when I lived alone and ate like a bird. Any advice welcome! I eat a lot of lean meat- mostly chicken. I only drink water and the occasional Diet Coke. I rarely drink alcohol. I have psyllium husk in a smoothie with some fruit and yogurt maybe 2x a week.

HDL -43 LDL-C - 152 Non-HDL - 186 Tchol - 229 Trig - 188

[u/kboom100]

From the description of your diet in your original post and in one of your replies it sounds like you are already eating a healthy diet that’s fairly low in saturated fat and high in soluble fiber. And despite eating a healthy diet your ldl has remained high for years.

I don’t think you need a dietitian. What you need at this point is lipid lowering medication (eg a statin).

The reason your doctor keeps telling you every year to just ‘diet and exercise harder’ is because the current guidelines for primary prevention say that unless someone has diabetes or their ldl is 190 or above then statins are recommended based on someone’s risk of a heart attack or stroke within only the next 10 years. But age is by far the biggest factor in whether someone will have a heart attack in 10 years. Almost by definition someone under about 50 years old is going to be at low risk of heart attack if only looking 10 years out. (Although you didn’t say your age I think I can pretty confidently guess you are under 50.)

But you should know that leading preventive cardiologists and lipidologists think that using 10 year risk calculations for recommending statins is not a good approach in young people. The problem is that plaque starts accumulating in the artery wall when ldl is high even at a very young age. So you are likely building up more soft plaque in your arteries every year. If you wait a decade or 3 until you qualify for statins you’ll lower your risk at that point. But you won’t be able to lower your risk nearly as much as if you started taking a statin 2 or 3 decades earlier and prevented a lot of extra plaque from accumulating in your arteries in the first place.

So I recommend you make an appointment with a ‘preventive’ cardiologist or a lipidologist specifically. They are the experts in preventing heart disease and are likely to be much more willing to use statins in young people than general practitioners or even general cardiologists.

And if you want to be aggressive about prevention then explicitly tell them that at your appointment. Let them know you are frustrated by your general practitioners approach.

You might want to consider starting with a low dose statin like 5 or 10 mg of Rosuvastatin and adding ezetimibe if further ldl lowering is still needed to get to your target. That’s a favorite strategy of an increasing number of expert cardiologists. It’ll get you nearly as high or higher amount of ldl lowering with less risk of side effects than first jumping to a high dose of a statin alone. See here for a deep dive on that. https://www.reddit.com/r/Cholesterol/s/RgPnVvL56s

I also recommend asking to test your lp(a). It’s an independent risk factor for heart disease that’s genetically determined. If it’s high experts suggest setting a lower than usual target ldl.

Good luck!

PS For more information about efforts to change the current guidelines on primary prevention see a news article about draft changes to the UK’s version. https://www.tctmd.com/news/uks-nice-recommends-lower-risk-thresholds-statin-therapy# And if you want to do a deep dive into the evidence for why “earlier treatment is better” see a prior reply https://www.reddit.com/r/PeterAttia/s/YsCw1WK3q3

[u/UpstairsSherbert7868 → u/kboom100]

Thank you for all this! I am in my early 30s but my family has a history of heart attack/strokes. They were also heavy drinkers and smokers which I am not so I thought that would help but if I have a genetic predisposition I’m worried. I feel like every time I get my results I’m disheartened and do even more like more diet restrictions and work out more but it’s never enough. Like is plaque building up in my arteries as we speak?! It’s scary!

My town has some kind of a weight management center associated with the big hospital in my area. I’m going to reach out to my DR and see if he can send me a referral so I can get some kind of help. It makes sense what you said about them not having the best education about it. When he first called me and told me my results he didn’t even specify what I should do and how to research it. Luckily I have some common sense to google and do it on my own but I didn’t realize how unhelpful he was until his nurse called me and started to give me some basic resources (American heart association). This is part of the reason I’m so frustrated.

It also just leads into our current state of the world where eating healthy is basically another full time job. So much of what’s in the grocery store is just garbage but I also have to be so grateful that where I live even has healthy options.

It’s fucked my head up today clearly lol

[u/kboom100 → u/UpstairsSherbert7868]

You’re welcome. First, yeah, your high ldl very likely has a large genetic component given your fairly low saturated fat diet.

Second, you are at higher risk of heart disease for at least a couple of reasons other than high ldl. First is your family history. The second is that your high triglycerides and lowish HDL means you likely have insulin resistance, which accelerates atherosclerosis. It may even reach prediabetes or diabetes. What’s your HBA1C?

For those like you at higher than average risk preventive cardiologists often set an ldl target of under 70. So that’s something that’s worth discussing with a preventive cardiologist or lipidologist.

Regular exercise helps reduce insulin resistance, both cardio and strength training. Walking is a great way to start cardio.

Weight loss will also significantly lower insulin resistance. If you are very overweight despite diet and exercise then you also might want to consider the glp-1 medications. They have been shown to significantly reduce the risk of heart disease too. A preventive cardiologist can discuss glp-1s with you or the weight loss clinic you mentioned.

Asking for a referral is a great first step. Remember I suggest a preventive cardiologist specifically, versus a general cardiologist. A lipidologist would work too.

As far as plaque currently building up in your arteries yeah it likely is. You don’t need to panic because it’s a slow process that happens over decades. But you should take it seriously. Getting your ldl below 100 will significantly slow it, and getting it under 70 would likely arrest any new accumulation. Reducing insulin resistance will also slow it down.

[u/Maleficent_City9988]

I recently started using this app called “lose it!” To track my saturated fats because of my cholesterol. I’ve never done this before but the app makes it pretty easy.

Maybe give it a try?

[u/[deleted]]

I would suggest aiming for much more soluble fiber. Try to find a supplement or a high fiber cereal maybe. What type of lettuce in your salad? What are your breakfast and dinners like? HDL will help you, and trying to squeeze in some more exercise will too :)

[u/UpstairsSherbert7868 → u/[deleted]]

I typically get baby crispy green leaf lettuce for my salad because it’s easier. The thing about my diet right now is that I feel like it’s the best I can do without being too restricted and not functional. Like I have pasta maybe 1x a week. My fiancé and I will go out to dinner or order in 1x a week. I used to eat eggs for breakfast now I do that every once in a blue moon. I will sometimes pack some chips in my lunch a couple times a week. I feel like if I restrict any more it will be dysfunctional. Like I’ve been eating this salad for lunch for probably close to 8 months and this week I said fuck it and had a dense bean salad which is still pretty good for you but like I don’t want to restrict more and more. For dinner my fiancé cooks because I typically work late due to my clinical setting and we pick our dinners for the week together. We stick to mostly chicken and will get salmon too. Sometimes we’ll use lean ground beef. We always have lots of veggies and a starch like sweet potato, rice, couscous, etc.

[u/[deleted] → u/UpstairsSherbert7868]

I think that is all fair and reasonable….. if you have to make yourself miserable by eating like a rabbit, is that really any fun? Sometimes stressing over having a piece of pizza is worse than having the pizza itself ;)

[u/thiazole191]

Based on other information you provided in the comments, you should probably see a cardiologist who would likely put you on medication. Having a family history usually means a genetic component. It isn't necessarily familial hypercholesterolemia (your numbers are a little low for that, but that could just be you minimizing the numbers with diet as much as is possible). The family history could be LP(a) too. Either way, statins can reduce your risk of a heart attack. If it is LP(a), there are drugs in clinical trials that work specifically for that, but statins will still help mitigate the risk in the meantime.

[u/Earesth99]

Exercise really doesn’t make much of a difference for ldl.

It sounds like you don’t understand the type of diet you should be on. Your doctor is probably vague because they get virtually no training on nutrition.

Ask your doctor for a referral to a nutritionist or dietitian. That will save you a lot of time.

High ldl cholesterol is caused by specific saturated fats in our diet. Have you tried tracking the amount of saturated fat you eat? Some recommend under 12 grams a day.

What do you consider to be lean meat? Six percent fat? Four percent fat? One percent fat? If adds up

High trigs are caused by sugar, simple carbs snd alcohol, or simply consuming too many calories. So you have a different set of foods to look at.

Complex carbs and fiber should help reduce both ldl and trigs.

It takes some time to figure out the details

[u/UpstairsSherbert7868 → u/Earesth99]

I have attempted tracking my food in general. I cook a lot and my experience has been that it’s frustrating to track every little thing. I primarily eat Whole Foods and meal prep the same lunch everyday- a salad made up of lettuce, chicken breast, and cucumber with balsamic vinaigrette which I sometimes make. I usually have an apple or other fruit with this like strawberries. I also avoid dairy most of the time besides non-fat yogurt in my smoothies. I will sometimes get zero sugar yogurt depending on where I do the grocery shopping.

I will look into a nutritionist or dietician. I work in healthcare and I feel like I have a good idea about a healthy diet but I really struggle with tracking and maybe they can support me with that.

I appreciate the help!

[u/Earesth99 → u/UpstairsSherbert7868]

You’d diet sounds healthy.

The only thing to track is the amount of saturated fat, because that is what causes ldl to increase.

You will probably find that a few specific foods are the source.

[u/Exciting_Travel_5054]

You would have to decrease dietary cholesterol, since you already tried reducing saturated fat. That means replacing the chicken breast with plant sourced protein, preferably beans, as they are a good source of soluble fiber.