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Thursday, September 18, 2014
I have been dieting and exercising and watching what I eat. My Dr. is monitoring me for Diabetes 2, but my sugar test came back normal at this point. All test results were good except for the bad cholesterol and the cholesterol count. It went from 202 to 262. Could that be due to sandwhich bread and mayonnaise or just heredity no matter what a person does??
The current guidelines as follows are:
- Total cholesterol <200mg/dl;
- LDL-c (bad cholesterol) <100mg/dl or <70mg/dl if you have heart disease;
- HDL-c (good cholesterol) >40mg/dl-men >50mg/dl-women.
However, as of 6/08 the ADA and ACC issued a joint improvement or revision of the recent guidelines with an emphasis on the use of apolipoprotein B (apo-B) or LDL particle number (LDL-P) as opposed to LDL-c as better predictors of risk for atherosclerotic vascular disease, especially in patients with insulin resistance, type 2 diabetes, and metabolic syndrome. Women are another group for which the traditional guidelines fail to stratify risk as accurately using conventional guidelines. These surrogate markers, apo-B and LDL-P, reflect how lipids are transported and packaged. It is now well known that when lipids are carried in smaller transport vehicles, there are more of them necessary to carry the cholesterol, and higher numbers confer higher risk. Clues that a patient might have higher particle numbers are a low HDL-c and TG>150mg/dl. In these patients, it is becoming clear that the LDL-c does not accurately reflect risk and thus a more detailed analysis must be done, i.e. apo-B or LDL-P to better assess risk. Not to confuse the issue further but a "poor mans apo-B" can be easily calculated from the conventional lipid profile by subtracting HDL-c from Total cholesterol (T. Chol. minus HDL-c=non HDL-c) which should be in the range of 30 points higher than the LDL-c goal. If it is significantly higher, this may reflect higher particle number and thus increased risk. A goal of 700-800 particle number may or may not correlate with LDL-c of 70-80 mg/dl in a traditional lipid profile; in fact, most of the time in insulin resistant patients and those with metabolic syndrome, there are significantly higher particle numbers than what would be predictive by LDL-c alone. We would encourage you to discuss these new guidelines with your primary, heart or cholesterol doctor to better define your risk, especially if you are a patient with insulin resistance.
Although heredity plays a major role in risk, exercise and dietary modifications can result in significant improvements in risk factor reduction and should not be overlooked or minimized in the therapeutic approach. Mayonnaise is considered a bad fat and could have caused a rise in the cholesterol level if you've been eating a lot of it; sandwich bread, not so much, as that is mostly carbohydrate. Continue to exercise and watch what you eat. Choose less from the high fat group (butter, cheese, whole dairy products, deep fried foods, processed foods, salad dressings etc) and choose more fruits, vegetables, whole grains, lean meats, soy products, and non-fat dairy products.
Connie A Gottfried, MPH, RD, LD, CDE
Case Western Reserve University
Laurie Sadler, MD
Formerly, Assistant Professor of Medicine
School of Medicine
Case Western Reserve University