Good and Bad Cholesterol, PAD and Your Veins

In recent years, we've told healthy eaters  to focus on 'good cholesterol.' That good cholesterol is also called HDL. And it's touted it's heart health benefits. Popular diet plans, like the Keto diet, focus on high fat intake. These suggest that eating good fats will be good for you!

What's behind this idea? The thinking is that LDL (bad cholesterol), not HDL,  causes plaque to build up in your arteries. This build-up, called atherosclerosis, then leads to conditions like peripheral arterial disease (PAD), and the fluid retention of edema. And when people have PAD,  blood flow from their heart to the rest of their body slows down. In turn, this can lead to pain, cramping, ulcers and blood clots. Furthermore, it increases the risk of hypertension, or high blood pressure, heart attack and stroke.

According to old beliefs, HDL moved LDL away from arteries and into the liver. That seemed to prevent the kind of plaque build-up that leads to PAD. Because of that kind of thinking, people were encouraged to eat foods that were rich in HDL, like olive oil, salmon and avocado. But now, research is turning that kind of thinking around, warning us that too much HDL can be just as 'bad' for your body as the other kind of cholesterol.

Foods to Lower Bad Cholesterol

We know that lowering cholesterol is only one piece of the puzzle. But if you want to fight bad cholesterol, look for foods with omega-3 fatty acids. These include ALA, or alpha linolenic acid, DHA or docosahexaenoic acid and EPA or eicosapentaenoic acid.

Oils, seeds and nuts are strong sources of ALA. But sourcing DHA is harder, since oily fish are the only food-based source for this omega-3.

But what fish are considered oily? Top choices include:

• Sardines
• Salmon
• Mackerel
• Anchovies
• Herring
• Swordfish
• Trout

To get enough DHA, you'd want to have up to four servings each week of these fish. But, while DHA is important for pregnant women, eating that much fish could raise your mercury levels. So you should limit your weekly fish intake and instead talk to your healthcare provider about DHA or fish oil supplements. You should also avoid swordfish entirely while pregnant or nursing.

Even with these dietary fixes, you can't get away with simply lowering bad cholesterol. Because, as it turns out, good cholesterol isn't a quick fix for everything. So keep reading to find out why.

The Problem with Good Cholesterol

In this Emory University study, researchers followed 6000 people with an average age of 63 to assess their risk of heart attack or death. As we might have expected from previous studies, participants with middling HDL levels (between 41–60 milligrams per decilitre) had the lowest risk of adverse cardiovascular events. People with HDL levels below that range did, in fact, show increased risk of heart attack.

But here's the shocking part: people with HDL levels ABOVE that range had the highest risk levels. In fact, their risk of cardiovascular events were increased by 50%! Scientists think that this increased risk is because, in high volumes, HDL may change its behavior. Instead of pulling LDL away from the arteries, it may actually transfer the LDL onto the artery walls, increasing people's risk of vascular diseases like PAD.

While the evidence is clear in suggesting that high HDL levels increase your risk of heart attack, it is not yet proven that too much good cholesterol is the actual cause of this increased risk. At the same time, it is fact that the 'right' amount of HDL can protect your heart health. Given these facts, our Houston vein specialists do not yet recommend changing your diet. Instead we suggest eating heart-healthy fats in moderation. That, combined with a sensible diet and exercise, should keep you in the proven 'safe' zone for cholesterol.

New Findings on Olive Oil

Even with warnings about good cholesterol, there's still evidence supporting olive oil benefits. In fact, a new study in Atherosclerosis says that daily olive oil intake protect against PAD. At the same time, it says that olive pomace oil (extracted from olive pulp) could increase your PAD risk.

The findings were part of PREDIMED-Plus, the largest nutrition trial study in Spain. It involved 4,330 participants. Researchers looked at the ankle-brachial index (ABI), considered a PDA marker. And tried to make a connection with patients' olive oil and olive pomace oil consumption.

What they found was interesting. Participants with the highest olive oil consumption had higher ABI readings. Which meant lower PAD risks.

And, based on those findings, researchers made an important conclusion. Patients at high risk for cardiovascular disease could help prevent PAD by consuming olive oil. And they could raise their risk by taking pomace olive oil. The study appears to confirm the benefits of following a Mediterranean diet. Which is balanced and full of other heart healthy foods. And likely keeps your good cholesterol levels in the right window.

What about the Keto Diet and Cholesterol?

In recent years, many people have turned to a high fat, low carb Keto diet in a quest to lose weight and boost energy. But what will the addition of all that good and bad cholesterol do to your diet in such high volumes? Well, according to new evidence presented at the American College of Cardiology's 2023 annual scientific session, following a Keto diet is associated with significantly higher levels of LDL or bad cholesterol in your body. As such, they concluded, this diet leaves you with a two-times higher risk for cardiovascular events including PAD.

Early Warnings about High Good and Bad Cholesterol

Here's what else we've learned about cholesterol and PAD. Once, we didn't worry about high cholesterol levels in young people. We thought they had plenty of time to turn the ship around, and take back control of their heart health. But now, a study from the Journal of American Cardiology has a dire warning. According to these findings, having high cholesterol in your teens and 20s is a major risk factor for PAD and other forms of heart disease.

What's behind these findings? It goes back to bad cholesterol, or LDL levels. Apparently,. the damage LDL causes to your arteries is irreversible. In other words, even if you bring down your bad cholesterol levels in your 30s, you may not be able to prevent hardening of the arteries. Given these findings, treating high cholesterol is critical at any age. Like vein treatments, delaying cholesterol interventions can lead to worse health conditions. Which means you must seek therapy at the first sign of a good and bad cholesterol problem.

Ready to take control of your cholesterol, vein and arterial health? We're here to help, and we suggest starting with a diagnostic ultrasound. With this tool, we can detect if cholesterol has caused any problems, and get you started on appropriate health care.

Sources: Atherosclerosis Journal, European Society of Cardiology, Science Daily, Journal of the American College of Cardiology