Penticton Herald

High cholestero­l with normal LDL needn’t cause worry

- KEITH To Your Good Health Readers may email questions to ToYourGood­Health@med.cornell.edu

DEAR DR. ROACH: My husband and I recently achieved the near impossible task of becoming attached to a family doctor. After many years without getting tested, our first order of business was a complete blood panel test, which – to our horror – showed that we both have high cholestero­l. Our results are almost identical with high HDL, normal LDL, good ratios and low triglyceri­des, but our total cholestero­l is flagged as high.

We are both 52-year-old endurance athletes of normal BMI. We aim for a Mediterran­ean-style diet, being mostly vegetarian, with no red/processed meat, minimal dairy, two cups of espresso per day and light red wine consumptio­n. Neither of us has a family history of high cholestero­l, or any type of heart disease.

We are non-smokers. A cursory look online shows that in some individual­s, endurance activities can raise total cholestero­l due to your body burning more fat for fuel. Could our endurance sports be altering our lipid profiles, and if so, is this something we need to be concerned about?

— Anon ANSWER: I’m sorry it took so long to find a doctor. The total cholestero­l does not provide as much predictive informatio­n as the LDL or non-HDL cholestero­l. Because total cholestero­l is a combinatio­n of LDL cholestero­l, which increases risk of heart disease (think “L for lousy”), and HDL cholestero­l, which generally decreases risk of heart disease (“H for healthy”), a high level is hard to interpret by itself. Since you know your LDL and HDL are both good, you shouldn’t worry about a high total cholestero­l. Of course, the actual numbers would be needed to make a more complete recommenda­tion.

Your dietary choices also sound quite healthy. But I could not confirm your online research about endurance activity and cholestero­l. It is clear that regular exercise increases the healthy HDL cholestero­l, but I found multiple studies showing no significan­t effect on LDL cholestero­l by exercise. More importantl­y, regular, moderate-level exercise clearly decreases the risk of heart disease. Extremely high levels of endurance exercise, far more than most people get, has been shown in some analyses to reduce the benefit seen by more moderate-to-active exercise.

DEAR DR. ROACH: Please put my mind at ease. Each time I go for blood work, I am told my white blood cell count is very low. I am now being referred by my doctor to a hematologi­st, who wants me to do more blood work to look for things such as leukemia.

Also, they are wanting me to do an ultrasound of my abdomen to assess my liver and spleen. I am just so worried about all of this.

They are saying that my levels have been low since 2019. I am so scared that I might have leukemia and only have a few years left to live. I’m scared of what the ultrasound will reveal. I’m 45 years old.

— J.E. ANSWER: Leukemia is very unlikely. Most leukemias have very high white blood cell counts.

Although there are leukemias and other related blood diseases with very low white blood cell counts, the fact that yours has been constant for at least three years suggests you may just have lower-than-average white blood cell counts.

This normal variant is especially common in people of African descent, Sephardic Jews, West Indians, Yemenites, Greeks and Arabs.

You are doing exactly the right thing seeing a hematologi­st, who, I think, really will put your mind at ease.

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