You can’t see a cholesterol lowering drug commercial without hearing some poor guy saying he tried everything, but diet and exercise just wasn’t enough.
Once I finish yelling at the TV and vomiting the remnants of my lunch in disgust, I’m reminded that this is just marketing.
The reality, however, is that exercise will not change cholesterol levels very much in the short run (pun intended). I remind patients of this frequently when we have discussions on cholesterol levels. If you want to bring your cholesterol back under control quickly, diet is the only answer.
But for many, the exercise component is much easier to adopt. Dietary changes are perceived as far more invasive. Walk around the block a few days per week? No problem. Avoid refined carbohydrates and processed foods? No way.
Exercise is the LONG term solution to cholesterol levels. This is because the vast majority of cholesterol issues are caused by being prediabetic. There are very few instances where prediabetes is NOT an issue, but it’s a pretty rare situation. Unfortunately, this little tidbit is rarely explained to patients by their doctors. Maybe it’s because most doctors don’t understand the relationship.
This does not mean that exercise is not important for short term management of cholesterol issues because it absolutely is. But all too often the benefits of exercise are not what you would expect them to be.
Patients get frustrated when they exercise and do not take off weight. I have covered the problem with this thought process in a previous blog post that can be read by clicking here.
(A quick note on my recommendations for exercise. I am a huge fan of short-burst aerobic exercise consisting of some variation of 30 second all-out bursts performed in 10 sets. I strongly do NOT feel that the standard “walk-30 minutes a few times per week” recommendations cut it. Hitting that anaerobic zone is very, very important and the straight walking for exercise protocols do not do it. This is likely why most studies on exercise do not have a short term effect on cholesterol levels. To read more about this feel free to read a prior blog article by clicking here.)
HDL (the “good”) cholesterol is not a single molecule. The reality is that there are some 100+ different forms of HDL cholesterol. But the biggest classification of HDL molecules is into types 1, 2 and 3. HDL (3) is generally considered the most protective form of HDL.
This has to do with an enzyme called paraoxonase-1 (PON1) that has very strong antioxidant properties. PON1 levels are higher in HDL (3) molecules, which likely accounts for the strength of the protection of this type of HDL molecule.
This means that even if you have a high total HDL number, it may not be as protective as you think if most of the HDL is made up of the 1 or 2 subtypes. Although more specific lab testing that includes these HDL subtypes is available, I have found a need to order these because the information from standard lipid profiles is enough for me to understand where your cardiovascular risk lies.
This particular study puts the concepts of exercise, prediabetes and HDL cholesterol subtypes into perspective. In it, researchers studied a group of 39 patients with prediabetes and put them into two groups: a control group and an exercise group who followed a 10-week walk/run training program.
Here’s what the researchers found:
- Exercise did NOT affect cholesterol levels.
- Exercise did, however, increase the activity of the antioxidant paraoxonase-1 (PON1).
- Exercise also decreased the levels of an oxidative stress marker called malondialdehyde.
- Even better, the HDL3 the exercising prediabetic patients protected the blood vessel walls from damage by the high-powered inflammatory molecule tumor necrosis factor-a (TNF-a).
- Exercise also decreased the ability of damaging immune cells to stick to the blood vessel lining (markedly decreased monocyte chemotactic protein-1, vascular cell adhesion molecule-1 expression as well as TNF-alpha-induced monocyte adhesion).
- Lastly, exercise also increased levels of endothelial nitric oxide synthase (leading to higher levels of nitric oxide, a molecule that relaxes the blood vessels).
These are all pretty darn potent and beneficial effects that have been shown to greatly protect against heart disease and stroke. If I had to balance the beneficial effects of these changes against a lower cholesterol level on protection from heart disease, they are not even on the same plane.
In other words, exercising led to very powerful effect on protecting your blood vessels from damage. Given that the bulk of the evidence suggests that statin drugs to lower cholesterol pretty much suck at preventing heart attacks, the review suggests that exercising, whether or not it results in lower cholesterol levels, is far, far more powerful at preventing heart attacks and stroke.
Remember this–you are not exercising to lose weight or to lower your cholesterol. You are exercising BECAUSE IT IS THE RIGHT THING TO DO.