Sunday, September 16, 2012

High Cholesterol in a Runner

So whenever I eat and worry about fat content, I am told that people are just sure that I don't need to worry about cholesterol. Well let me tell you how WRONG you are! At 11 I had a total cholesterol level of 250. This would be of concern in a middle aged person. My mom was a health nut and I played sports. I still had a level of 250. My doctor put me on a diet where I could eat nothing with over 25% fat including cheese, egg yolks, ice cream, etc. and my cholesterol dropped down to a level of 180. Turns out cardiovascular disease runs in both my mom's and dad's family. Seems to have skipped both my mom and dad, but hit me somehow; my grandfather died at 45 while taking a dump.

I have tried to adhere to a low-cholesterol diet and I haven't gotten my cholesterol checked in over 10 years because I didn't want to go on medications and I didn't want to change my diet.

I finally got my cholesterol checked this past week and the verdict is: 205! I am so relieved, this means with making my diet just a bit more rigid, I can go back to the optimal range. I have a VERY VERY high LDL and an okay (not great) HDL level. LDL is what tends to deposit oxidized cholesterol into one's vasculature and HDL can have the capability to remove oxidized cholesterol from the vasculature.

Apparently what happens with me according to this test is I have a very high absorption of fat. This means that what I eat, I absorb. There are many people with low fat absorption. So the amount of nutrition someone else gets from 1 egg yolk, I can get from 1/8 of an egg yolk.

The way this test shows this is with sterols, which are plant-based cholesterols. Mine are through the roof!!! There is a condition called sitosterolemia that I probably have. It is genetic, autosomal recessive meaning my parents were heterozygotes (each containing one normal and one mutant gene). This also explains why my parents and sister all have normal cholesterol, but I have high cholesterol. The genes responsible are the cholesterol transporters that absorb cholesterol from the gut and also pump bile into the gut to assist with fat absorption.

In summary, mutation of these receptors means "defective secretion into the bile of dietary sterols, increased intestinal absorption of plant and dietary sterols, hypercholesterolemia, and early-onset atherosclerosis". The best drug for this specific (uncommon) reason for high cholesterol is one that decreases absorption of cholesterol, ezetimibe.

The alternative is that I can just not eat cholesterol and be extremely conscious that I need to eat about 1/8 the total fat of that others need. I am willing to do this and stay of medications for a bit longer :) But PLEASE don't tell me not to worry about eating a burger with full fat. I need to worry about that. It means the difference between life and death for me.

            The problems that cause more people hypercholesterolemia are quite diverse and they include non-responsiveness to a high fat diet. So one's body continues to synthesize cholesterol despite eating too much fat already. This is not MY problem, as the markers of cholesterol synthesis are on the low end of the optimal range. For this group of people, statins would be more appropriate.

I will also begin taking Niacin (Vitamin B3) and omega-3 fatty acids, but I will discuss why after my next exam :)


  1. This is all really interesting to me (especially since I have a sig other who had heart disease). Thanks for posting!

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    Best rgs

  3. Hi Courtney, I don't see any other way to contact you about this issue, but am curious what came of your experience here with high cholesterol as a runner. It doesn't look like you run the blog anymore, so I hope this message gets through.

    I was recently diagnosed with sitosterolemia, which I only really found out about because of my experiencing decline with running. My main symptom was anemia. It is unclear here whether you had the test for phytosterols in your blood to suggest or confirm sitosterolemia. Also, it's unclear whether you were confirmed to have hypercholesterolemia and what you've done about it besides adjust diet. I'm curious because there are currently only about 100 people in the world diagnosed with sitosterolemia, and it is very difficult to sift through symptoms to diagnose. So, it would be surprising to me if you arrived at that diagnosis, and even more curious to me what your experience as a runner has been with such a condition. Hypercholesterolemia's symptoms can be similar to sitosterolemia's (anemia though to a lesser degree), so I am also curious what your experience has been as a hypercholesterolemic runner, if that's the case.

    Any info/insight you can provide is appreciated.