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Q: Cholesterol
My TG's (triglycerides) have been high, and now my cholesterol is above 200. I take Agenerase and am at 0 viral load, 610 t-cells. I eat only egg whites, soy, non-fat milk; no meat, only albacore tuna every day or salmon. I eat both fresh and canned, choosing brands that guarantee omega-3 retention. My question is: I take 1-2 tablespoons of Barleans Lignan Rich Flaxseed Oil (cold press) every morning. Is this going to help my cholesterol level? How much of this oil should I take? I eat roasted sunflower seeds, pumpkin, walnuts, etc. I bake my own bread, no eggs. I exercise one hour every day on my bike and weight-train 4-5 times per week. I'm 5'7", 160 lbs, and male. Do I need to start a cholesterol-lowering drug? Which is best? Also, I've had bouts of enzymes getting high, taking drug holidays etc. I mega-dose milkthistle tea and decaf green tea all day. Liver seems fine, now. I am concerned about plague in the arteries. Also, should I take baby aspirin as the American Heart Association suggests? (April, 2000)
A: Donna Tinnerello, MS, RD, CD/N responds:
Congratulations on your high T cells and zero viral load. High triglycerides and cholesterol seem to be a side effect of the protease inhibitors. Agenerase is a protease inhibitor that, by the way, has 1700 IUs of vitamin E. So you definitely do not want to take any more supplemental vitamin E with your Agenerase. And allow me to jump to the end of your note here where you ask about a baby aspirin to prevent arterial plaque build-up. Vitamin E and aspirin are both blood thinners. This is how they prevent heart attacks and strokes, by preventing blood clots. Blood clots block the arteries and don’t allow blood flow to and from the heart and the brain.
All blood thinners that are over the counter should be taken cautiously by PLWHIVs (People Living With HIV) or anyone for that matter, especially if you have any history of thrombocytopenia. This used to be a big problem in the HIV+ population and still is cause for concern. You also want to be cautious if you are on any pharmaceutical blood thinners like Coumadin.
I am impressed by the fact that you bake your own bread. Your diet seems healthy, you seem to be avoiding most fat, and mainly you don’t eat animal fat, favoring skim milk, soy, and egg whites over whole eggs. Make sure you get enough protein. Other good sources of protein are white meat chicken and other types of fish besides the tuna and the salmon. Trimmed red meat occasionally can’s hurt either.
Triglycerides are blood fats. High fat meals cause spikes of TG in the blood as does excessive sugar intake and alcohol. The omega 3 fatty acids that you are getting from the tuna and salmon, as well as from the walnuts, should be helping to keep the TG in check. Omega 3 supplements are used to lower TG, but you seem to be getting quite a bit already, especially if you eat these foods every day. Furthermore, I would not recommend supplemental omega 3 in your situation because it is yet another blood thinner in the same sense as the vitamin E and aspirin. Dietary omega 3 should be fine.
You asked about flaxseed oil (Barleans Lignan Rich Flaxseed Oil). I have never heard of this brand, but flaxseed and flaxseed oil are rich in omega 3 similar to the omega 3 found in the fish and walnuts. Again, you have blood thinner here. The oil is likely to help lower TG levels, but if I were you, I would think about using flaxseed (ground) itself instead of the oil. This is a good source of soluble fiber. Soluble fiber has a great reputation for lowering cholesterol. Other sources are oatmeal, legumes (dried beans) and other whole grains. This way you get two for the price of one (omega 3 and soluble fiber). You can grind the seeds in a coffee grinder and sprinkle them on cereal or casseroles, add them to smoothies, or just bury them in stews and soups. The oil is fine as far it goes, but you can’t cook with it and you don't get any fiber in it.
You have to be careful not to avoid fat altogether. Sometimes we tend to think that avoiding dietary fats altogether is the solution. Some fat is essential and there are good fats and bad fats. The good ones like omega 3 that we mentioned above, as well as the monounsaturated fats like olive oil or canola oil, should not be avoided. You also need some omega 6. I see you are eating sunflower and pumpkin seeds, but you might also want to try gamma linoleic acid (GLA). This is supplemental omega 6 and can be purchased as borage oil or primrose oil-capsules to ensure the balance between the omega 3 and omega 6.
You seem to have eliminated the saturated fat like whole milk, butter, cheese, and red meats and that is a good thing.
Exercise is key and you seem to be doing just that. You might be interested to know that the timing of exercise might be influential in lowering your TG levels. Working out before meals seems to be preferable to exercise after eating. One of the problems with TG is that high blood levels decrease the good cholesterol (HDL) and raise the bad one (LDL). So you want to keep these blood fats low if at all possible.
Your weight seems to be fine at 5’7” and 160# for a male.
Your question regarding the possibility of using a lipid-lowering drug is a good one. I usually say it’s up to you and your MD, and that is especially so if you try all of the above and you don’t see a change in the blood fats. High total cholesterol, high LDL, and low HDL are a risk factor for heart disease.
In short, my advice is to avoid sugar and concentrated sweets as much as you can and increase fiber. Instead of white flour products in most breads and pastas, try brown rice, whole grain breads and pastas if you aren't already. Use monounsaturated fats and keep on with your omega 3 foods, nuts, and seeds. Instead of the flaxseed oil, try the ground flaxseed and up the soluble fiber unless you are already doing that. Keep up with your exercise. The bike is good and I'm glad you do some resistance exercise too. A lot of people overlook that but it's important to hold onto that lean body mass.
