High cholesterol: the numbers now considered normal

High cholesterol: the numbers now considered normal

Do I have high cholesterol or not? The question comes from a 38-year-old man who doesn't smoke or drink and brings his blood test under his arm. In some places his figure shows up in red; in others, within range. The confusion isn't his: it's anyone's who has watched the thresholds move without anyone explaining when or why.

That consultation opens a discussion that has dragged on for a long time and has moved from the specific doubt to the heart of the matter: what cholesterol and triglyceride numbers really miccionan. Along the way, two very different cases appear: the man with no vices and the one who arrives with 780 triglycerides and 250 grams a day of sunflower seeds in his history. With that material, the answers range from the recommendation of four walnuts a day to the suspicion that it's all a business.

Why 250 total cholesterol no longer means what it used to

According to one forum user's memory, there was a time when a total cholesterol figure of 230-250 was grounds for congratulations at company health checks. Anyone today still at those values gets the opposite warning: watch out. The shift is explained, as noted in the thread, not by a change in anyone's body, but by the arrival of stratification tools such as SCORE and the Framingham model, which no longer look only at the total number.

The most repeated argument is that total cholesterol, on its own, says little. It doesn't matter if it's 250 if HDL is good and LDL is reasonable; the real problem appears when high total cholesterol coexists with low HDL and uncontrolled LDL.

Ratios matter more than the isolated figure

A fine reading of the test involves the ratios: total cholesterol divided by HDL, and triglycerides divided by HDL. When both are in order, some argue there's no reason to panic over a high total. The figure repeated as a reference is that LDL should be below 100, with an optimal level of 70.

By that yardstick, a profile of 250 total with HDL 90 and LDL 100 is not especially significant; another with HDL 20 and LDL 200 is a different story. One technical detail often overlooked: the sum of HDL and LDL does not equal total cholesterol, because both are transport proteins, not separate compartments.

The case that breaks the pattern: 780 triglycerides

The second protagonist starts with 250 triglycerides and a diet he considers beyond reproach: white meat, oily fish, vegetables, legumes, zero sweets and only extra virgin olive oil. He starts on the seeds and quits tobacco, and the figure jumps to 400. Then to 700. And at the last check, to 780, despite the diet.

The suspect singled out is the seeds. He consumes 250 grams a day, an amount some describe as compulsive. His total cholesterol rose from 224 to 270 and his HDL stayed at 25, a value considered low. His rural family doctor, with twenty years of experience and in a village where most consultations are for cholesterol and triglycerides, prescribes Pitavastatin plus fibrates with one goal: get it down to 400 in three months.

The liver also enters the picture. Some ask for a Fibroscan to rule out cirrhosis associated with long-standing fatty liver, and some recall that soaring triglycerides miccionan you have to look at blood pressure and the rest of the risk factors before deciding anything.

Saturated fat versus carbohydrates: the dietary shift

One axis of the debate is that the enemy isn't always fat. Against classical doctrine, it's argued that high triglycerides come from carbohydrates that the liver converts into fat when they aren't burned off, not from pork belly or cheese. The recommendation circulating: cut out oats and seeds, raise protein to 1.5 grams net per kilo of body weight, and don't antiestéticar butter or eggs.

The other voice points to the imbalance between omega-6 and omega-3. Sunflower seeds are a load of omega-6 polyunsaturates, and excessive consumption tips that balance. It's even claimed that too much omega-6 inhibits the thyroid and that this, in turn, pushes cholesterol up. The detail of the full diet, with percentages and equivalents, isn't broken down anywhere.

The statin war

No subject heats things up more. On one side, the claim that statins are a time-delayed bomb, that they lower testosterone and affect vitamin D, bones and cognitive function. On the other, the response from someone with medical training: the only serious problem to monitor is that they don't cause myopathy or inflame the liver, and for that, transaminases and CPK are checked at one month and three months after starting.

The demand for serious bibliography against unsupported claims is constant, as is the request not to confuse an opinion with data. In the highest-risk case, it's recalled that type 1 diabetes puts cardiovascular risk on par with having already had a heart attack, and that there the conversation allows no shortcuts.

Walnuts, salmon and weights: homegrown remedies

The list of homemade recipes is long. Exactly four walnuts a day divided into three doses, half an hour before each meal. Quit the seeds and walk 45 minutes a day. Lift weights until all parameters come out right. Half a kilo of salmon a week after losing weight, with an HDL that in one case reached 147.

There are also those who boast of having spent a lifetime between 250 and 300 cholesterol without medication, and those who at 22, hypermuscular and eating three eggs for breakfast, saw high values for no apparent reason. The sarracena drawn from all these cases is uncomfortable: habits matter more than any supplement.

With that kind of material on the table, the sensible thing would be for cholesterol figures to stop dancing depending on which clinic you walk into. They're still dancing. And in the meantime, everyone keeps the number that suits them best.

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Note: this article summarizes an exchange of opinions about health and does not constitute medical advice. Any decision about medication or diet should be discussed with a professional.