Out of the Blue
A friend called me the other day concerned that her LDL ("bad") cholesterol levels had soared. After she lost 20 pounds several years ago, her total cholesterol had dropped to 190. Now, it was suddenly at 240, with an LDL reading of 147. (Doctors generally say LDL should be no more than 130, and some are advising it be 100 or below.) Besides being concerned, my friend is confused. She can't think of anything she is doing differently. What's going on? For answers, I spoke with Bruce R. Gordon, MD, professor of clinical medicine and surgery at Weill Medical College of Cornell University and co-director of The Rogosin Institute's Comprehensive Lipid Control Center in New York. Surprisingly, Dr. Gordon says that it's common to see a 30- or 40-point spread from one cholesterol reading to another because many things can affect cholesterol levels, even day to day. Do not draw conclusions from one high reading.
MANY IMPACTING FACTORS
Age is one of the first things I wondered about, but Dr. Gordon says that while cholesterol does tend to rise with age, it is a gradual ascent. Rather, he said that the biggest culprit in raised cholesterol is steroids such as the ones used to treat asthma attacks. Beta-blockers (for the purpose of addressing high blood pressure) also can produce increased levels, but Dr. Gordon says that the rise is generally not significant. Since there is so much talk about the importance of diet and cholesterol control, I asked if what you eat can make an immediate difference and the answer is yes -- and no. The population is divided into diet-sensitive and diet-resistant people. Some people can eat a meal or two that is high in fat and other rich foods, and their cholesterol levels will immediately zoom. Others, says Dr. Gordon, can starve or gorge themselves at a meal or two and it will make no difference either way in terms of fluctuations.
SOMETIMES CHOLESTEROL GOES DOWN, TOO
Interestingly, being injured or being sick -- a chronic illness or having a cold, the flu or any other kind of acute illness -- can bring cholesterol levels down. Dr. Gordon says he suspects this is because the body is using its cholesterol for other metabolic purposes, such as combating the illness or injury.
COMPLIANCE IS KEY
Compliance is a big issue with fluctuating cholesterol, says Dr. Gordon. People who stray from healthy diet practices and regular exercise often will pay the price with rising cholesterol. For those on statins, being lax about taking medication (a situation Dr. Gordon reports is far too common) results in higher cholesterol immediately. Stress, too, is an interesting element in the cholesterol picture. Dr. Gordon says it isn't the stress itself that changes the body -- rather it's a behavior issue. When stressed, people tend to reach for fatty comfort foods, to forgo exercise and be lazy about remembering their medications, all of which lead to higher cholesterol in many people. Contributing editor Andrew L. Rubman, ND, adds that in addition to reaching for comfort food, stress impacts the body's creation of, use of and sensitivity to a myriad of compounds that are related to the production and use of cholesterol, making it yet another reason to keep stress under control.
Perhaps the most surprising reason of all for fluctuating levels, says Dr. Gordon, is simply lab error. Because of the relatively high incidence of lab error, Dr. Gordon advises anyone who has had low cholesterol readings over a period of years and then sees a sudden increase to go back in a few weeks for another test. If you've been sick, though, hold off having your cholesterol checked because you're apt to get a lower reading than what actually reflects your usual levels. How long to wait depends on how sick you were. After a cold, you should wait several weeks... after coronary bypass surgery, several months. Also, fast overnight before the test for best results. Fluctuating levels are an important and interesting aspect of cholesterol management. According to Dr. Gordon, one test does not tell the whole story. If your counts are high, talk to your doctor about what else has been going on in your life that could impact the levels. And consider repeating the test several times to be sure there is a pattern to your counts.