Is “Bad Cholesterol” Getting a Bad Rap? For Women, This May Be the Case.
- Chloe Hope, MS RDN-AP LD
- Apr 14, 2019
- 5 min read
Historically, being a man meant an increased risk of stroke. This notion translated into changes in emergency treatment when men presented to the the emergency department with signs or symptoms of stroke. Recently, research has indicated that women not only have a higher prevalence of stroke, but that the effects are more severe and that the excess of women who die from stroke is increasing, dramatically. Sadly, part of this can be attributed to the differences in symptoms that women have with stroke and even the efficiency and effectiveness of treatment. And perhaps most alarming, women between the ages of 45 and 54 are the fastest growing population being affected by stroke.
Okay... so how does this relate to nutrition, you may be asking. Hold on to your seats, we’re about to get nerdy.
There are two basic classifications of stroke; ischemic and hemorrhagic.
The ischemic stroke is the most common of strokes (about 85%) and is, in simple terms, a blood clot that moves from one area to another and limits blood flow to a specific or multi-region part of the brain. When that part of the brain loses it’s blood supply, it can be damaged in a way that affects the body’s ability to perform certain functions. Sometimes that area can heal and repair to the point that the functions return. Other times the damage is permanent and consequently, the loss of function is also permanent. Under a worst case scenario, the damage is severe enough that it results in death. Often, if the symptoms of ischemic stroke are identified early enough, and treatment is initiated, the long term effects can be minimized and the risk of death decreases significantly.
The hemorrhagic stroke is less common (about 15%), but has a tendency to be more difficult to treat than an ischemic stroke. In a hemorrhagic stroke, the vessels in the brain rupture. In a subarachnoid hemorrhage (SAH), those vessels are found between the brain tissue and the skull. There is a two-fold effect of the hemorrhage - not only does the blood flow cease, but the blood that flows from the rupture fills the space between the brain and the skull which creates pressure. That pressure, in turn, can begin to impact not only the portion with loss of blood flow, but the brain as a whole. In an intracerebral hemorrhage (ICH), a vessel deep within the brain ruptures. Just like the SAH, the ICH disrupts the blood flow to other regions of the brain and creates increased intracerebral pressure. This pressure can build up so much that the brain gets “squished” - I know, fancy terminology there! But that’s exactly what happens. In fact, under the worst conditions, and unfortunately the most likely to cause death, the brain will actually “squish” down through the bottom of the skull.
Yes, Chloe, this is all good to know (and maybe even more than you wanted to) but where’s the nutrition part? I’m getting to it. I promise.
Apparently, the good folks at Neurology (a peer-reviewed clinical journal) decided it was worthy enough to do an early release of a study (formally published in May) that examined the role of “bad cholesterol” or low density lipoprotein (LDL) and triglycerides in hemorrhagic strokes in WOMEN! This prospective study included more than 27,900 women, from middle-age to elderly and looked at the risk of hemorrhagic stroke when LDL and triglyceride levels were below norms. What they found flies in the face of the typical guidance offered by physicians (and other practitioners) regarding cholesterol levels in women; a lower is better notion. In fact, when LDL levels were less than 70, the relative risk for hemorrhagic stroke increased dramatically.
Why, you might be thinking, would this be the case? Especially when all we’ve heard for the last 30 years or more is that “bad cholesterol” is nothing but “bad”! The jury is still out on the exact mechanism by which this effect occurs. But it is speculated (by a LOT of forward thinking folks, I might add) that LDL and triglycerides play a role in the integrity of the vessels themselves. So theoretically, when the body doesn’t have “enough” the vessels aren’t maintained/repaired in a way that keeps them strong and resistant to the effects of things like high blood pressure.
Drum roll. Here’s what you’ve been waiting for. The nutritional aspect of all this candor!
So you find out your cholesterol is high. The following monologue is what you might expect:
“Your cholesterol is too high. You need to eat less fat. You need to exercise. And here is a pill that is going to lower it.”
Look/sound familiar? Yeah, that’s what I thought. And that’s not to say that this is what you’re going to experience with every single physician or practitioner. But it’s pretty typical. There’s no guidance on what kind of fat to “eat less” of. There’s no guidance on how to begin an exercise routine. There’s a complete lack of direction on what foods might be added or to eat more of to help this condition. There’s no discussion about stress levels. And before you’ve had a chance to make any kind of changes at all, you’re given a pill. To prevent your risk of stroke, you’re given a pill which has a side effect of... hemorrhagic stroke! Added to that, there’s diarrhea, insomnia, limb pain, muscle spasm, musculoskeletal pain, myalgia, nausea, etc. And that’s just one of the drugs that you might be prescribed.
As a Dietitian who specializes in functional nutrition, my approach is to maximize the healing and beneficial effects of food and minimize reliance on non-nutritive agents to manage diseases or conditions that are directly related to diet... and aren’t they all?? One of the things that I can help you manage is a high cholesterol level without needing a drug to reduce it. By using quality foods and addressing the many factors that contribute to your health, you can get your cholesterol to levels that are optimal, not just lower. Studies like this are the proof that “lower” still needs to have a definition - it still needs to be a level that your body can do its functional best.
After all, isn’t that the heart’s desire? To function at our best without needing any medications to do it? To live a life free of “side-effects”? Seems a little fantastic, but I assure you, it’s possible.
Make an appointment with me, today, to discuss your individual health and nutrition needs. A list of foods will only go so far. I want to help you be the best you can be.
Healing the whole you through nutrition, movement, and hope.
Rist, P., et al. “Lipid levels and the risk of hemorrhagic stroke among women.” Neurology® 2019;92:1-9. doi:10.1212/WNL.0000000000007454, https://n.neurology.org/content/neurology/early/2019/04/10/WNL.0000000000007454.full.pdf. 13 April 2019.
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