[elhudy]

I am close with someone who has chronic high cholesterol, in addition to a 6-pack abs. She exercises 5x/week and eats .5kg of animal products/week at most, usually white meat. She just visited her heart Dr and was told that her cholesterol is too high and that she needs to cut out animal products entirely as a next step.

I am thinking...is this really the modern answer to someone's high cholesterol if they consistently exercise, are nearly underweight, and rarely eat animal products to begin with? It doesn't add up to me.

It's amazing how little we still know about heart disease - the #1 killer in the US. As someone who will inevitably inherit chronic high-cholesterol as well, I'm excited to read and share this ongoing research. Thank you for posting this.

[omgwtfbyobbq]

It may not. Her doctor could be erring on the side of caution. Also, cutting out animal products completely could demonstrate that her high cholesterol is due to something besides her diet which should open up referrals to a specialist and other kinds of testing.

In my experience, as a patient with some unknown problem, the less experienced a physician is, even if they are a specialist, the more likely they are to try to match up your issues with what they know and hand wave away any inconsistencies. When you get to an expert, if there are inconsistencies they will straight up say they don't know what's going on and will start looking into it (running tests, trying different meds, etc).

[josefresco]

Both my parents are vegan, thin, active, eat basically the same things but one has "bad" cholesterol numbers and one has good. We know so little!

[Ekaros]

It could be entirely genetic. Worst case could be that some groups just tend to die earlier from these diseases... There could be some somewhat invasive medications to fix thigs. But they are likely very far away...

[tharkun__]

Define earlier. My great grandpa was vegan too. Since WWI. Thin (but not tall :))and had high cholesterol. Died in his 70s.

[tharkun__]

I have high cholesterol. Used to eat normally. Was on statins. Highest dose doctor would prescribe. Got muscle problems. Doctor took me off statin coz it might be the heart muscle at some point.

Unrelated to this I tried Keto a bit later. I did actual real keto with less than 20g of carbs. Probably higher on the protein side than normal but loooots of fat definitely and eggs and bacon and all the other cholesterol stuff.

All of my other bad blood values completely normalized. Cholesterol went down slightly but not much but LDL/HDL ration improved. I didn't get the test to check for size and makeup of the cholesterol molecules done (not covered/done here) but I bet you it would've confirmed that I had a lot of but mostly the fluffy type of cholesterol (the good type).

[ChrisIsTaken]

My LDL dropped by three quarters once I switched to a keto(ish) diet a decade ago and stayed down. My HDL remained stable, almost like the body manufactures it for cell walls or something...

[moltar]

This would explain it: https://youtu.be/jZu52duIqno

[MisterBastahrd]

My grandmother has been diagnosed with high cholesterol since I was a toddler.

She's 104 years old and survived COVID this summer.

[simonhughes22]

Similar - my grandfather is my only grand parent with high cholesterol, he's now 93 and has out lived all my other grand parents and his sister. It's clear to me that there's a lot here that we still don't understand.

[jandrese]

For one it's a statistical risk factor, not a guaranteed death sentence. There will always be outliers.

[wirrbel]

In my family all the cooking/frying is done with clarified butter. Butter, cheese, definitely no margarine/crisco, plant oil only for salads. So far no cardiovascular problems.

[dv_dt]

The interesting side effect to me here is using butter one might keep the cooking temperatures a little bit lower. Butter burns at a lower temp than many plant oils.

[ominous_prime]

The solids in butter are what burn quickly. Clarified butter burns at 230°C, which is at the higher end of cooking oil smoke points.

[draw_down]

Not clarified butter; it's clarified so that it can be cooked at higher temps (it also keeps longer). Clarified butter has a higher smoke point than several plant oils.

[TimedToasts]

> She exercises 5x/week

What kind of exercise: cardio, yoga, resistance/weight training, other? There have been a number of studies showing that regular weight training improves cholesterol numbers (1,2) and I have seen it personally. Regular weight training causes cells to repair/recycle their cholesterol, removing it from the bloodstream. (Cardio may or may not do this as well but I'm a proponent of weight training as the foundation of health.)

Also: after reading the article, I think that cholesterol turnover rate is the key here. Cholesterol that is regularly used up and replaced does not have time to damage your vascular system like cholesterol that hangs around and hardens on your walls.

1) https://pubmed.ncbi.nlm.nih.gov/24174305/ -- Differential effects of aerobic exercise, resistance training and combined exercise modalities on cholesterol and the lipid profile: review, synthesis and recommendations

2) https://pubmed.ncbi.nlm.nih.gov/33343671/ -- Regular training has a greater effect on aerobic capacity, fasting blood glucose and blood lipids in obese adolescent males compared to irregular training

[Matrixik]

We know a lot about heart disease but it looks like most look for magic drug instead of underlying process.

Check Dr. Malcolm Kendrick long series on "What Causes Heart Disease" (list of all posts from drmalcolmkendrick.org):

https://www.emotionsforengineers.com/2018/01/dr-malcolm-kend...

[JeremyNT]

I've always had high-ish cholesterol. I dramatically cut down on carbs and animal protein (no meat at all, but still some dairy and eggs) which resulted in only modest improvement to LDL.

I do cardio at least 3 times a week and train a form of calisthenics (push ups, pull ups, dips, etc) at least three days a week.

It doesn't really do much for the numbers. I think some people just draw the short straw on cholesterol.

The trick to it is that cholesterol is only one of many subtle risk factors in cardiovascular health. As this article suggests, it's obviously not the case that high cholesterol is universally associated with worse outcomes, and there's no guarantee that improving the test scores will provide any benefit for an otherwise healthy patient. Does the doctor look at the whole person and their exercise regimen and conclude it's not worth medicating for the cholesterol risk? Or do they consider that lowering cholesterol can improve risk even further and so recommend medication? There's actually a protocol here that includes cholesterol as only one factor.

Ideally, a model like the one in this article could help better understand who to actually treat. We know cholesterol is a reliable proxy for risk at population levels, but if it could be ruled out for individual parents that would be very helpful.

[viraptor]

Could be also something like https://en.wikipedia.org/wiki/Familial_hypercholesterolemia where it's just due to genes and bad luck. You can do generic tests for it, but they're relatively expensive. Statins mostly help bring the numbers down.

[tharkun__]

Emphasis on mostly. Check my post above. It's genetic for me most probably (I'm the 4th generation w/ high cholesterol and we cover most of the combinations of vegan/carnivore/fat/thin). Statins have bad side effects that can kill you outright. To think I'd been on statins since 16 years old (for round about 25 years... )

[viraptor]

In this case I meant mostly as in "out of things they do, the big effect is on the cholesterol numbers". We still don't really know if they help with heart diseases or not. As far as I understand it, that still relies on the unproven hypothesis that lowering cholesterol numbers does improve the outcomes.

[UncleOxidant]

Did the doc do any kind of test to determine current levels of plaque in the arteries? There's a test that's done via ultrasound (IIRC) on the carotid artery that can give a pretty good idea of current plaque levels.

[mywittyname]

I'm in a similar situation (granted, I do eat meat 5-6 days a week). And I have no idea what to do about it except go vegan.

I suppose there's a genetic component, as no man in my known family lineage has made it past 60.

[finnh]

My paternal grandfather and great grandfather both died of cardiac arrest in their 50s. My Dad has always had high cholesterol but went on drugs as soon as they were available - first Niacin, then statins. He's still doing great at 75 and very much thinks the pills are to thank.

[wtetzner]

Well, if the theory in the article is correct, then high cholesterol may not be a bad thing.

[mgh2]

Did she consider sugar intake? https://www.npr.org/sections/thetwo-way/2016/09/13/493739074...

[isoos]

It may be that she has insulin intolerance / resistance, it may be worth to check for it. I've heard a similar case, and after the insulin intolerance treatment was ongoing for a while, the cholesterol level dropped.

[Bellamy]

It's almost a miracle that a doctor recommends a dietary approach and not describing a pill. Huge step into a right direction.

This shows that doctor's actually know that a diet and other lifestyle factors are the key to health. Not eating pills.

[nofnziti]

There are many more dietary sources of saturated fats than just meat.

[elhudy]

Edited to say "animal products" rather than meat.

[nofnziti]

I wasn't trying to nitpick your comment. Even excluding animal products it's still possible to eat a diet high in saturated fat.

[elhudy]

No worries, I should have just said she "eats healthy".

[nradov]

Saying that someone "eats healthy" is so vague as to be meaningless.

[elhudy]

can't please everybody :)

[hn_throwaway_99]

But dietary cholesterol itself only comes from animal products, which is probably why the Dr. said to cut out all animal products.

[tharkun__]

What I have found and read recently-ish about as well is that dietery cholesterol will actually not have any bad effect on the cholesterol in your bloodstream. If I eat eggs and bacon my cholesterol basically stays the same as if I don't and my body just manufactures more of the bad stuff.

https://www.health.harvard.edu/heart-health/how-its-made-cho...

> In fact, cholesterol production is so important that your liver and intestines make about 80% of the cholesterol you need to stay healthy. Only about 20% comes from the foods you eat

[vsef]

This is not true for all people, sensitivity to dietary cholesterol intake is individually variable. My cholesterol responds very strongly to dietary cholesterol intake, when I do not eat eggs yolk, shrimp etc, my cholesterol is close to ideal. When I do eat them my numbers go extremely high and I am recommended to take a statin. I am in my 40s and this has been very consistent since I was in my 20s. If you read more studies related to this you will find that there are absolutely populations of dietary cholesterol responders and non-responders.

[nofnziti]

And saturated fats are linked to higher LDL. What are we disagreeing about?

[airstrike]

Does she eat a lot of sugar?

[moltar]

Take a look at this: https://youtu.be/jZu52duIqno