Ask Dr. Roach: High total cholesterol is OK as long as LDL is normal

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?

— Anon.

Dear Anon. >> 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 has been shown 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.

Dear J.E. >> 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 the right thing seeing a hematologist.

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