Peter Baer (alpenglow) wrote,
Peter Baer
alpenglow

Cholesterol

I have a pretty lousy cholesterol profile, and a family history of heart disease (all on my mother's side: my grandmother died of a heart attack in her 60's, one of my uncles had a nearly fatal heart attack in his 40's, and my mom came within minutes or hours of a heart attack at 59 and ended up having quad bypass surgery). So, kinda bad. Something's gotta be done.

A couple of years ago I took advantage of the new Microsoft "executive health" benefit that allowed me to get a much more thorough physical than the usual annual checkup. The tests included a stress echocardiogram and a scan for calcium deposits in the coronary and carotid arteries (which measures plaque buildup). Fortunately these tests came back clean, so while I am at high risk for heart disease, I have not actually developed it yet to any measureable extent (although autopsies of teenagers have shown that evidence of plaque can begin to appear at a very early age).

Last year I bought a CardioChek Portable Blood Test System that lets me test the main cholesterol indicators (total cholesterol; HDL, or "good" cholesterol; and triglycerides, which is a measure of the "fattiness" of the blood) at home and get instant results. I was finding it difficult to stick to any kind of diet, exercise or supplement regimen without frequent feedback on whether it was doing any good or not. From that perspective heart disease is harder to manage than, say, obesity, because there is nothing about your external appearance or how you feel that correlates to how badly your arteries are clogged up (it takes a lot of blockage to reduce the flow of blood to the point that you would notice any symptoms like shortness of breath, fatigue, etc., and most heart attacks are the result of a more sudden blockage caused by a piece of plaque breaking off somewhere and getting stuck in a narrower part of the blood vessel). The 3-month bloodwork checkups I'm supposed to be having are too far apart for this purpose.

The CardioChek system uses single-use test strips for each cholesterol indicator. Using a spring-loaded lancing device (it extends and retracts a tiny needle within a fraction of a second, too fast to see), I prick a fingertip and use a capillary collection tube that sucks up 15 microliters (about one fat drop) of blood into it. A test strip goes into the device and I squeeze the blood onto a little target on it that absorbs the blood. The CardioCheck then shines light onto the absorbent pad from underneath and measures the reflected light. Using a little flash memory chip supplied with every test strip batch containing the expected response curves of the test strip after it's reacted with the blood, the CardioChek computes and displays the measurement value. This is repeated three times for each measurement (though I only have to prick my finger once, since I fill up all three capillary tubes first). The whole process from start to finish takes about 10 minutes. Since accurate values require a 10-12 hour fast, I can do this after sleeping in on a typical weekend day, with no real planning required, other than remembering to avoid a midnight snack the night before.

The test strips are rather expensive ($2 each, so $6 for a full test). But that's a small price to pay if this helps me stay on track with my cholesterol management goals.

After testing myself only sporadically last year, a month ago I started measuring HDL weekly and all three components every other week. HDL is my worst value and the things I am doing (exercise and niacin supplements) are specifically aimed at increasing it. I also take fish oil supplements, which are supposed to be good for cardiovascular health overall but also increase LDL ("bad" cholesterol), so I keep track of how much of that I'm taking as well. Finally I also log my workouts.

I started a new niacin regimen in January after a recent study showed that the "no-flush" niacin I had been taking for years is actually useless for improving cholesterol. The most effective form turns out to be cheap, immediate-release niacin, which has the notorious "flushing" side effect (a high enough dose will turn my neck and chest bright red, hot and tingly for about 20-30 minutes).

Here are my stats since the beginning of the year. I got sick in early February and that knocked me off of my workout schedule pretty hard. Also I was out of capillary tubes last week so no HDL measurement.

WeekNiacin (mg/day)Fish Oil (mg/day)Exercise (days)TotalHDLTriLDL
1/3/090480052813054240
1/10/0962548005
1/17/0975048004
1/24/091000480042753457230
1/31/09125048003 36
2/7/0912504800229037
2/14/09150048001
2/21/091500480022343560187


Total cholesterol (234 mg/dL): Less than 200 is good; more than 240 is bad. This value has large variability in my measurements; today's measurement is actually the lowest since I got the CardioChek, but it bounces around a lot. My highest reading was 283 last November right after Thanksgiving.

High Density Lipoprotein (35 mg/dL): More than 60 is good; less than 40 is bad. HDL is considered the "good" cholesterol because it transports other cholesterol back to the liver. As you can see, I started the year at 30, which is horrible, but the niacin really does seem to be working: as I ramped up the dosage (it takes a while to build tolerance to the flush), it has gone up to as high as 37. In the past two weeks it has slipped back to 35, which may be due to me skipping my workouts. Of course I need a further 10-15% improvement just to get to the "borderline bad" category; getting to 60 or above may be impossible without medication.

Triglycerides (60 mg/dL): Less than 150 is good, more than 200 is bad. This is the only stat where I have nothing to worry about. The large quantity of Omega-3 fatty acids in the fish oil I've been taking is probably a major reason. The fact that I'm skinny and have had very stable weight (I've been in the 140-145 lb range for the last 15 years) could be correlated to this as well - maybe I metabolize fat very efficiently.

Low Density Lipoprotein (187 mg/dL): Less than 100 is good, more than 130 is bad. This is not measured directly (at least not in my home test) but derived as an approximation from the values above: LDL = Total - HDL - Tri/5. LDL is the "bad" cholesterol that can lead to plaque buildup. The HDL/LDL ratio should be 0.4 or higher; mine is 0.19.

There is a vocal fringe that believes the correlation of high cholesterol levels with heart disease is just a remarkable coincidence being exploited by the pharmaceuticals to sell drugs. It's true that cholesterol is not intrinsically bad and is in fact essential (you need it to build cell walls), and cholesterol isn't the only factor in heart disease (for example, the exact mechanism of how plaque builds up and breaks apart is not very well understood) but it's hard to ignore the basic statistical fact that people with high cholesterol are likely to end up with heart disease sooner or later. And heart disease is, as they say on the news, "the nation's #1 killer."

I hope this is one genetic trait that I don't pass on to my children. There is some cause for optimism in that book_fairy has a perfect cholesterol profile and no family history of heart disease (her values were already pretty good before she started her 20/20 program, and she ended with these amazing values: 157 total, 81 HDL, 59 LDL).

I'd really like to achieve a reasonable cholesterol profile without relying on prescription drugs, to which I'd have to commit for the rest of my life and whose side effects may not be fully understood. I hope that by paying close attention to the impact diet, exercise and supplements are having on my stats, I can find a mix that works for me.
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