My annual lipid panels identified hypercholesterolemia for over the past 20 YEARS (now 56). Transitioned to a healthy plant based diet (thanks Michael Greger) in 2021-2022, but still only saw about 15% improvement (my husband responded ideally). Had docs telling me for yrs not to worry, women run higher, individual levels vary per endogenous liver production etc. After a constellation of stressors common at this time of life (menopause, parents dying, kids leaving home, pandemic...), 6 mo ago I got confirmation of my suspicion of Addison's disease (actually PAS2 since I have had Hashi's since my first child was born). Since starting treatment my lipid numbers have dropped dramatically, showing the benefit of that healthy plant based diet. If I hadn't deteriorated, statins would've been the normal course and the underlying insufficiency wouldn't have been uncovered. I suspect many more people have latent adrenal insufficiency, esp those like me who have a relevant family history (again ignored for decades by various docs who should've dug into that but didn't, even upon my asking). I'd like to suggest that people with intransigent hypercholesterolemia rule out hormone imbalances including cortisol insufficiency (my liver was pumping out cholesterol presumably in response to persistently high ACTH asking for more cortisol). Advancements on the horizon like U-Rhythm will hopefully help. Check out the food related links on this page: https://www.u-rhythm.co.uk/biological-rhythms
Hi Jill. This is an incredible story--everyone can learn so much from what you have been through. Good for you for sticking to the basic science of lipids and perservering on getting your cholesterol down. And yes, much good info in Dr. Greger's books and on his site. Thyroid disease is one of the more common conditions causing dyslipidemia so doctors know to screen for that. But Addison's is more of a zebra and often gets missed. It is probably more common than we think.
Thank you for all of this information. I'm concerned reading about the danger of lipids that go up and down over time. At what percentage of change does it start to get dangerous in regards to AD? Thank you!
Hi Anne. Yes, it has recently been described that wide fluctuations of lipids may be harmful. With regard to AD, I really can't say if there a certain change in level is a red flag. Lower is best!
Hi Lindsay, great question. The American College of Cardiology/American Heart Association guidelines wrt lipids has not been revised since 2019. The AHA doesn't recommend testing for ApoB and does not include this in its guidelines (an update should be coming soon.) The 2021 Canadian cardiovascular guidelines recommend keeping ApoB under 80 mg/dL. The 2022 World Heart Federation guidelines recommend keeping ApoB under 80 mg/dL if high risk or under 100 mg/dL if moderate risk. These positions stem in part from this 2021 JAMA Cardiology paper that showed that each standard deviation increase ApoB increased the risk of heart attack by 38% in low risk people (no history or risk factors. https://jamanetwork.com/journals/jamacardiology/fullarticle/2786333
Love this article and the analogy of the rafts on the Snake River. How does the post menopausal hormones affect women in terms of their lipid testing? I wonder this since coronary artery disease is the number one killer in post menopausal women. Thank you for having such a great newsletter!
Hi Norene! Great question. Women are protected from CVD until they go thru menopause. By 10 years postmenopause, their CVD risk has caught up to men's. One of the reasons is probably that estrogen keeps LDL low and HDL high. It's very common for the numbers to get out of whack starting at menopause. HRT taken at menopause (not years later) prevents this worrisome trend.
And PS, I didn't get tested for LP(a), highly elevated, until I was 67 and on my way for an angiogram!! Docs always said CVD I had was due to diet and exercise! I killed it in both categories and they nearly killed me! That's when I got a new doctor and started my own research on nutrition, functional medicine, and Brain Health Kitchen. I'm 72 now, living large, all thanks to my new doc and my determination to live healthier for all my days.
Really appreciate the clarity of your writing and distilling info from research. This has been the trouble with our Healthcare focus, or lack thereof. Such good info and breakthrough thinking happening but getting the word out is a challenge and Healthcare industry too slow on the uptake. Thank you!!! Best money I've spent all year!
Hi Annie, I've always had low cholesterol on my regular lipid panel but this time I asked for these additional tests you recommended. This time my total cholesterol was 171 with a LDL of 97, Triglycerides of 49, HDL of 64 and APO-B of 81. These scores concerned me a little but most concerning is that my LPa came back 72.6. What do you recommend about this? Thanks so much!
Wow Rachel, I am so glad you got it checked! I recommend working with a preventive cardiologist. Your primary care practitioner should be able to refer you. Email me if you need help finding someone.
I requested that ApoB be included in my last lipid panel, and it’s not even in the system, so I had to order my own, just as with Lp(a). Hopefully this changes SOON! Great information, Annie. ❤️
About 10 years ago the USDA guidelines told us to limit the cholesterol we eat because it increased our blood serum levels of cholesterol. We now know that is not true except for people with a genetic disorder called hypercholesteremia. However, the science behind that recommendation was based on researchers force feeding high cholesterol foods to rabbits who are vegetarian. Yes … their cholesterol went up as a result!
Annie, this is fascinating. Still trying to get my head around all the detail. Question: do you know any way to reduce HDL-C? I have read similar studies about very high HDL-C being associated with higher risk of heart disease. Mine is consistently over 100. Just curious. Thanks for this incredibly detailed information.
Hi Sally. HDL goes down with less aerobic exercise and more sat fat foods. The focus has always been to increase HDL, which we now know does not reduce cardiovascular events so it probably doesn't help brain health either. Knowing there is an optimal range rather than the higher the better is totally new. It sounds like an HDL of 100 is just right. More detail about the high HDL studies linking it to Alzheimer's: one study suggests high HDL is harmful if high blood pressure is also present, another suggests high HDL is a reflection of lipid dysfunction and high ApoB. If you don't have either, having a high HDL may not be a red flag.
Wow! This was so informative. My overall cholesterol is 186. LDL hovers around 104-107. Can’t seem to get it lower. Will discuss with my cardiologist and look forward to your next newsletter on nutrition. Thank you!!!
I have had high cholesterol for a very long time, with a history of heart disease on my dad’s side. My calcium score was 0 and the doctor was very patient with me but kept nudging me to take statins. I started in March and my blood levels have responded as hoped.
I look forward to your article on statins. I have always heard so many negative things about them.
I've used statins for 20 yrs. Very effective. Started at 10mg, then 20mg, then 40 MG, then 80mg. This higher dose was very effective at lowering LDL to near perfection, however, after a year or so liver enzymes started rising to concerning levels. After much testing I now take 40 MG. Still investigating liver enzymes but has decreased appropriately. Appears to be linked but not conclusive, yet.
My annual lipid panels identified hypercholesterolemia for over the past 20 YEARS (now 56). Transitioned to a healthy plant based diet (thanks Michael Greger) in 2021-2022, but still only saw about 15% improvement (my husband responded ideally). Had docs telling me for yrs not to worry, women run higher, individual levels vary per endogenous liver production etc. After a constellation of stressors common at this time of life (menopause, parents dying, kids leaving home, pandemic...), 6 mo ago I got confirmation of my suspicion of Addison's disease (actually PAS2 since I have had Hashi's since my first child was born). Since starting treatment my lipid numbers have dropped dramatically, showing the benefit of that healthy plant based diet. If I hadn't deteriorated, statins would've been the normal course and the underlying insufficiency wouldn't have been uncovered. I suspect many more people have latent adrenal insufficiency, esp those like me who have a relevant family history (again ignored for decades by various docs who should've dug into that but didn't, even upon my asking). I'd like to suggest that people with intransigent hypercholesterolemia rule out hormone imbalances including cortisol insufficiency (my liver was pumping out cholesterol presumably in response to persistently high ACTH asking for more cortisol). Advancements on the horizon like U-Rhythm will hopefully help. Check out the food related links on this page: https://www.u-rhythm.co.uk/biological-rhythms
Hi Jill. This is an incredible story--everyone can learn so much from what you have been through. Good for you for sticking to the basic science of lipids and perservering on getting your cholesterol down. And yes, much good info in Dr. Greger's books and on his site. Thyroid disease is one of the more common conditions causing dyslipidemia so doctors know to screen for that. But Addison's is more of a zebra and often gets missed. It is probably more common than we think.
Thank you for all of this information. I'm concerned reading about the danger of lipids that go up and down over time. At what percentage of change does it start to get dangerous in regards to AD? Thank you!
Hi Anne. Yes, it has recently been described that wide fluctuations of lipids may be harmful. With regard to AD, I really can't say if there a certain change in level is a red flag. Lower is best!
Thank you!
Great article! Would you mind posting the source for the revised Apolipoprotein B guidelines?
Hi Lindsay, great question. The American College of Cardiology/American Heart Association guidelines wrt lipids has not been revised since 2019. The AHA doesn't recommend testing for ApoB and does not include this in its guidelines (an update should be coming soon.) The 2021 Canadian cardiovascular guidelines recommend keeping ApoB under 80 mg/dL. The 2022 World Heart Federation guidelines recommend keeping ApoB under 80 mg/dL if high risk or under 100 mg/dL if moderate risk. These positions stem in part from this 2021 JAMA Cardiology paper that showed that each standard deviation increase ApoB increased the risk of heart attack by 38% in low risk people (no history or risk factors. https://jamanetwork.com/journals/jamacardiology/fullarticle/2786333
Love this article and the analogy of the rafts on the Snake River. How does the post menopausal hormones affect women in terms of their lipid testing? I wonder this since coronary artery disease is the number one killer in post menopausal women. Thank you for having such a great newsletter!
Hi Norene! Great question. Women are protected from CVD until they go thru menopause. By 10 years postmenopause, their CVD risk has caught up to men's. One of the reasons is probably that estrogen keeps LDL low and HDL high. It's very common for the numbers to get out of whack starting at menopause. HRT taken at menopause (not years later) prevents this worrisome trend.
And PS, I didn't get tested for LP(a), highly elevated, until I was 67 and on my way for an angiogram!! Docs always said CVD I had was due to diet and exercise! I killed it in both categories and they nearly killed me! That's when I got a new doctor and started my own research on nutrition, functional medicine, and Brain Health Kitchen. I'm 72 now, living large, all thanks to my new doc and my determination to live healthier for all my days.
Wow, what a story. Thankfully you are your own best advocate.
Really appreciate the clarity of your writing and distilling info from research. This has been the trouble with our Healthcare focus, or lack thereof. Such good info and breakthrough thinking happening but getting the word out is a challenge and Healthcare industry too slow on the uptake. Thank you!!! Best money I've spent all year!
Thank you Kathleen! They say it takes an average of 17 years for medical advances to become embraced in daily life. I am trying to change that!
You go girl!
Hi Annie, I've always had low cholesterol on my regular lipid panel but this time I asked for these additional tests you recommended. This time my total cholesterol was 171 with a LDL of 97, Triglycerides of 49, HDL of 64 and APO-B of 81. These scores concerned me a little but most concerning is that my LPa came back 72.6. What do you recommend about this? Thanks so much!
Wow Rachel, I am so glad you got it checked! I recommend working with a preventive cardiologist. Your primary care practitioner should be able to refer you. Email me if you need help finding someone.
Thanks Annie, sending an email now.
I requested that ApoB be included in my last lipid panel, and it’s not even in the system, so I had to order my own, just as with Lp(a). Hopefully this changes SOON! Great information, Annie. ❤️
Good for you for being a trailblazer:)
About 10 years ago the USDA guidelines told us to limit the cholesterol we eat because it increased our blood serum levels of cholesterol. We now know that is not true except for people with a genetic disorder called hypercholesteremia. However, the science behind that recommendation was based on researchers force feeding high cholesterol foods to rabbits who are vegetarian. Yes … their cholesterol went up as a result!
It's true! Those rabbit studies are famous. It turns out rabbits metabolize cholesterol way differently than we do.
Annie, this is fascinating. Still trying to get my head around all the detail. Question: do you know any way to reduce HDL-C? I have read similar studies about very high HDL-C being associated with higher risk of heart disease. Mine is consistently over 100. Just curious. Thanks for this incredibly detailed information.
Hi Sally. HDL goes down with less aerobic exercise and more sat fat foods. The focus has always been to increase HDL, which we now know does not reduce cardiovascular events so it probably doesn't help brain health either. Knowing there is an optimal range rather than the higher the better is totally new. It sounds like an HDL of 100 is just right. More detail about the high HDL studies linking it to Alzheimer's: one study suggests high HDL is harmful if high blood pressure is also present, another suggests high HDL is a reflection of lipid dysfunction and high ApoB. If you don't have either, having a high HDL may not be a red flag.
Wow! This was so informative. My overall cholesterol is 186. LDL hovers around 104-107. Can’t seem to get it lower. Will discuss with my cardiologist and look forward to your next newsletter on nutrition. Thank you!!!
My guess is that he or she will be thrilled that you are up to date. Yay!
This is the best lay person's explanation of this subject I've ever read. Thanks!
Thanks Martha! Please share--I find that there is so much misinformation and misunderstanding about this topic.
Thank you Annie, super helpful!
Thanks for reading!
Annie,
I have had high cholesterol for a very long time, with a history of heart disease on my dad’s side. My calcium score was 0 and the doctor was very patient with me but kept nudging me to take statins. I started in March and my blood levels have responded as hoped.
I look forward to your article on statins. I have always heard so many negative things about them.
Thanks for sharing your work, Annie!
I am so happy to hear this! Yes, there is a lot of fear, much of it unwarranted.
I've used statins for 20 yrs. Very effective. Started at 10mg, then 20mg, then 40 MG, then 80mg. This higher dose was very effective at lowering LDL to near perfection, however, after a year or so liver enzymes started rising to concerning levels. After much testing I now take 40 MG. Still investigating liver enzymes but has decreased appropriately. Appears to be linked but not conclusive, yet.
Excellent article. So informative. Thanks Annie!
Thanks for reading Cynthia. Hope you are enjoying this beautiful fall.