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A Personal Story About Cholesterol

Updated: Oct 16, 2023

We all know diet and exercise make a positive difference for our health, but the nerd in me loves to see the data shift along with the habits.

This is a deep-dive on how the changes I've made to the way I eat and move have affected my cholesterol over the years. This is by no means scientific as I am only telling my own story, though I feel there is value in others’ experiences so I wanted to share. (If you're short on time and would rather skip ahead to recommendations for healthy cholesterol, click here.)


Coupe on the beach in Hawaii
Me at 28ish in a rainstorm on Oahu w/my now husband

First, a little background…

The first time I had any awareness about my cholesterol, I was 24. At the time, I was lean and exercised regularly, so I was surprised to learn that it was slightly elevated. It wasn’t terribly high, but I was young and wanted to correct it before it got worse. I spent some time researching and quickly learned that my diet (which was high in processed and restaurant food and low in produce and whole grains) was likely an issue.


Over time, I went from cutting out red meat and eating more veggies to being vegetarian. I was vegan for a few years too. I kept my eye on my total cholesterol but didn’t pay attention to any other numbers. My cholesterol improved dramatically and stayed below 200 for 24 years.


It can be easy to assume this shift was about what I REMOVED, but it was likely also about what I ADDED. I ate less saturated and trans fats and more vegetables, fiber, and monounsaturated fats. I also went from being a casual gym person to enjoying endurance sports, finishing four sprint triathlons and three half marathons.


Based on my experience, though, I believed that diet was the key to keeping my cholesterol in check.


But, there was more to the story…



Fast forward to perimenopause…

In 2021, going through perimenopause, I gained nearly 15 pounds and none of my usual ways of managing my weight seemed to work. This is a story I’ve heard from a lot of other women too. I have some thoughts about why this was the case for me, but let’s stay focused on cholesterol!


In July of 2021, my weight was up even though I had been strength training and doing a fair amount of running. I had blood work done and learned that my cholesterol had begun to climb back up. It was still not super high, but at 200 it was higher than it had been since 1997. In addition, I noticed my LDL (“bad cholesterol”) was creeping up as well. Interestingly, though, my HDL (“good cholesterol”) was the highest it had ever been (a very good thing!).

Between 2021 and 2022 I was able to lose the 15 pounds (thank you macros and nutrition coaching!). During this time I stopped running and focused only on strength training and walking. Once I was back down to my normal weight, I expected my annual blood test to show a BIG improvement…


It did not.


My total cholesterol was a little lower but my LDL had not changed and my HDL had dropped (not good!).


Why?


I wasn’t sure, but I didn’t believe diet was the issue. I hadn’t stopped eating veggies or gone back to eating meat (though I am no longer vegan). But I was only strength training and not running or doing any other aerobic exercise aside from walking.


This time, my research lead me to learn about the impact of different modalities, durations, and intensities of exercise on cholesterol. What I read suggested that adding some aerobic/cardio exercise could help to increase my HDL and possibly lower my LDL. I decided to add a bit of running back into my routine to see if I could get my numbers to shift.


What does the research say?

There are several studies that evaluate the effects of exercise on lipid profile for varying populations. The results consistently show that HDL (“good cholesterol”) is the most likely to be affected and there appears to be a linear dose–response relationship between HDL and increased energy expenditure that seems to transcend the mode of exercise.


What does that mean? The more calories you burn by doing exercise of any kind, the more you can raise your HDL.


The research also shows that the intensity of aerobic exercise (as % of max HR) and volume of strength training (# of reps and/or sets) also make a difference. To affect LDL and triglycerides, it takes higher intensity cardio and/or increased volume of resistance training- higher volume is more helpful than higher intensity for strength training.

Based on the research, the best exercise plan for lowering cholesterol might include 150+ minutes of exercise per week spread over most days and including:

  • Strength training

  • Moderate to high intensity cardio



On the Road Again

After my somewhat disappointing blood work at the end of 2022, I decided to experiment with changing my exercise routine to see if I could get my lipid profile to shift. In January, I started to slowly add some short runs and I was able to build up to a few miles at a time fairly quickly. I ran a couple of 5k races (one was my fastest time EVER!) and then I got a crazy idea…


In July, I turned 50 and (this is where the crazy idea comes in!), decided to train for my fourth half marathon. I hadn’t run that distance in 10 years, so I wasn’t sure how it would go. I also wanted to see how all that running would affect my cholesterol.

Routine before (4 days/wk):

  • STRENGTH TRAINING: 4x/wk strength training (~4 hrs/wk)

  • CARDIO: none aside from daily walks

Routine starting in July (6 days/wk):

  • STRENGTH TRAINING: 3x/wk strength training (~3hrs/wk)

  • CARDIO: 3 runs/wk (gradually increasing from ~1-4hrs/wk while training for a 1/2 marathon, moderate to high intensity)


The Results

In September (after nearly 9 months of running), I had my blood work done again and got very encouraging results! Every lipid marker* improved (as did my blood pressure and resting heart rate, though both were already in the healthy range):

Total cholesterol: -3.6%

HDL: +8.5%

LDL: -9.3%

Triglycerides: -5%



*A note about lipid blood markers: I am aware that apoB and LP(a) are becoming more common markers used in determining cardiovascular health risk, however, those are not often ordered in a standard workup in the US, at least not for me, and may or may not be covered by insurance depending on the plan.


So, was it the running? Yes, but also not exactly.


Let’s look at what changed:

  • Dose of exercise increased from ~4hrs to a max of ~7hrs/wk

  • Added moderate and high Intensity cardio

  • My weight and diet did not change (though I did keep a close eye on saturated fat, aiming to keep it below 10% of my calories)

Adding the moderate and high intensity cardio likely had an affect but adding more strength training volume could potentially have had a similar affect if I were able to handle that large of an increase! That said, there is only so much strength training I can do each week, so a balance between the two modalities is ideal to reach a higher volume without doing more of one kind of exercise than I can recover from.



Me wearing Urban Cow Half Marathon finishers medal

In case you are wondering, the half marathon went well! I had some struggles at the end of my training plan but still managed to run the race within a minute of my PR from 2013!


What’s Next?

My goal as a menopausal and newly 50-something woman, is to stay focused on health. To me that means building or maintaining muscle and bone density and keeping my cholesterol and other health markers in check. It is also important to me to be ready for whatever adventures cross my path so I can fully enjoy life with the people I love.

I won’t be running as many miles as I was the past few months, but I do intend to keep some running in my schedule. I will continue strength training and throw in some additional adventures like hiking, kayaking, or snowshoeing too. It will be interesting to see how things change over the next few years as menopause can affect lipid profile, blood pressure, muscle mass, bone density, and so many other things.


8 Recommendations for Healthy Lipid Levels

  • Eliminate trans fats

  • Keep saturated fat to 10% or less of total calories (<6% if you need to lower your cholesterol). Multiply total calories by .1 then divide the result by 9 to get max saturated fat in grams

  • Consider supplementing with krill oil (see Omega-3 fatty acids note, below*)

  • Eat plenty of fiber (gradually increasing to 25-30g/day is a good place to start) with foods like berries, broccoli, brussels sprouts, cauliflower, lentils, beans, chia seeds, nuts, whole grains, and air-popped popcorn (food > supplements)

  • Exercise on most days for a minimum of 150 minutes/week and include moderate to high intensity strength training (75-85% 1 RM) and aerobic exercise (50-85% max HR)

  • Don't smoke

  • If you drink alcohol, keep it to a moderate amount at most

  • If you're carrying extra weight, consider working to reduce your body fat (hint: a nutrition coach can help! 🙂)


*What about fish oil and Omega-3 fatty acids? The effect of fish oil supplementation on lipid profile is controversial. It may be cardio-protective and may lower triglycerides, but it may also increase LDL cholesterol. Krill oil is not as well researched, but the studies that have been done look promising for lowering cholesterol (study here) and also building muscle (study here).

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