(contributed by Yvonne Ou)

Justin chasing Yvonne at the Tamalpa XC race in 2011.

Justin chasing Yvonne at the Tamalpa XC race in 2011. (photo by Malinda Walker)

the last few months have been exciting (if not bone breaking) thus far: justin asked me to marry him (wait, did i just come out to the pamakids on the soonar or later blog?), i fractured my fibula during the cooldown after betty cunneen’s bench dedication and MLK workout around lake merced, and during an annual exam i requested a cholesterol check and discovered my donut-eating ways may be catching up with me after all. while i don’t run nearly as much as i used to (2 days max per week), and some have suggested running is bad for me (see above re: recent fracture), i still exercise almost 6 days a week and ride my bike to and from work. not only that, but justin and i follow what i thought was a fairly healthy diet — we don’t cook meat at home, so most of our home-cooked meals are full of goodies like whole grains, kale, chard, beans, occasionally fish, and wine. wine is supposed to be good for your cholesterol, right? ok, so maybe the daily baked goods and chocolate to satisfy my sweet tooth take a toll. and i admit, i enjoy a high-fat, high-calorie restaurant meal and super bowl sunday gluttony too. but seriously, how can i have high cholesterol — i’m a runner!

this is not the first time my cholesterol has been high. i had my cholesterol checked during medical school prior to starting a medication. it was high then, but my doctor thought i ate too much shrimp and didn’t seem concerned. after all, i was a marathon runner back then. if memory serves me right, the cholesterol did come down the next time it was checked. both of my parents are on statins, so could genes be playing a role? as long as one doesn’t experience side effects, i’ve often joked that statins should be in our drinking water. but when faced with the option of taking a medication vs. making lifestyle changes, i’ll gladly sign up for the latter. when i googled “diet changes to lower cholesterol” and read the harvard heart letter recommendations, i realized i’d already incorporated a lot of the foods. so now i’m considering going on an actual “diet” to lower my cholesterol. i’ve never done a regimented “diet,” but maybe now i have the motivation to actually GET IT DONE. so this first blog post poses these questions: have you had your cholesterol recently checked (recommendations are that adults over age 20 have it checked every 5 years)? which diet would you recommend (i’m considering the ornish, TLC, and engine 2 diets)? perhaps our resident pamakid nutritionist and soonar or later blog editor will weigh in, but i’d love to hear any comments — especially from vegans — please feel free to post below. i love to cook, so will share some heart-healthy recipes that are pamakid-tested as i go along and attempt to lower my cholesterol — my plan is to get it rechecked in 3 months.

my cholesterol as of feb 6, 2013
total cholesterol: 220 mg/dL; suggests borderline cardiovascular risk
triglycerides: 81 mg/dL; desirable
HDL cholesterol: 55 mg/dL; acceptable
LDL cholesterol: 149 mg/dL; suggests borderline cardiovascular risk

John and Yvonne cheering on the runners at the PAUSATF XC Champs in Golden Gate Park in 2012.

John and Yvonne cheering on the runners at the PAUSATF XC Champs in Golden Gate Park in 2012. (photo by Malinda Walker)

Response from John Gieng:

First off, congratulations to you and Justin!

Diet-wise, you said you already follow many of the recommendations in the Harvard Heart Letter. Additionally, you a fairly active person despite being injured and not running much. These are good things and may indicate that your lipid numbers aren’t as bad as they seem.

According to experts, the desirable blood lipid profile:
Total cholesterol: <200 mg/dL
Triglycerides: <150 mg/dL
HDL cholesterol: >60 mg/dL
LDL cholesterol: <100 mg/dL

Just some facts: Everyone has their own set-point so comparing your values to a standard cutoff or range is moot. Your total cholesterol and LDL cholesterol are high and close to borderline cardiovascular disease risk. Your HDL is good indicating decreased cardiovascular risk. One thing to know about total cholesterol is that it is notoriously a bad stand alone indicator of cardiovascular disease risk. What you really need to monitor is changes in total cholesterol over time. Second, LDL cholesterol actually includes a spectrum of varying size sub-particle classes. It’s possible that your LDL comprises mostly large-buoyant particles and less small dense particles. This pattern is associated with good health despite high total or LDL cholesterol. Together with the lipid profile, you should also have a look at your fasting blood glucose and hsCRP (inflammatory marker). If these two indicators are out of desirable range (70-92 mg/dL for glucose and ❤ mg/dl for hsCRP), then likely your high lipid indicators are of concern.

In regards to dietary recommendations, there are multiple one’s that have shown a benefit in regards to improving your blood lipid profile. A recent study in the American Journal of Clinical Nutrition have shown that in a weight loss situation, it isn’t the macro-nutrient composition (carbs, proteins, and fats) that make the difference in effectiveness to lower cholesterol. This suggests that reducing energy consumption alone by 10-20% may be effective. If eating less isn’t your style, I would definitely recommend reducing the amount of vegetable-based oils (like canola, corn, and soy) and the products that use them (lot’s of the pre-packaged processed food) and increasing the healthy omega 3-fats, especially from cold water fish or algae sources. Two other nutrients I recommend are vitamin D (supplement if you’re not in the sun 30+ minutes/day) and magnesium (think green leafy stuff). All of these items will boost your energy metabolism and immunity, which are both critical to normalize blood lipid levels. Lastly, that glass of wine most certainly has been shown to be of cardiovascular benefit. Keep up the good work and good luck!