#104 Cholesterol, Cancer Treatment and Food

Navigating the complex world of health post-cancer treatment and as we age, cholesterol management often stands out as a prominent concern.

While a common belief is to simply restrict dietary cholesterol, the reality is more nuanced. Not every individual's cholesterol levels are solely influenced by diet.

In this episode, we'll dive deep into the multifaceted factors that can raise or lower cholesterol. By the end, you'll be equipped with actionable lifestyle insights and valuable talking points for your next discussion with your healthcare provider. Tune in and take a proactive step towards a healthier you!

Resources:

Dietary Cholesterol and Cardiovascular Risk: A Science Advisory From the American Heart Association

How it's made: Cholesterol production in your body

Take control of rising cholesterol at menopause.

Cholesterol Levels: What the Numbers Mean

The effects of aromatase inhibitors on lipids and thrombosis

Read Full Transcript Below:

0:01
This is Laura Lummer, the breast cancer recovery coach. I'm a healthy lifestyle coach, a clinical Ayurveda specialist, a personal trainer, and I'm also a breast cancer survivor. In this podcast, we talk about healthy thinking and mindfulness practices, eating well, moving your body for health and longevity. And we'll also hear from other breast cancer survivors who have reengaged with life and have incredible stories to share. This podcast is your go-to resource for getting back to life after breast cancer.

0:38
Hello, and welcome to another episode of the breast cancer recovery coach Podcast. I am your host Laura Lummer. Thank you so much for being here with me today. I hope you're doing well here in California. We are starting to see things reopened again. It's a little weird because as we're reopening finally from COVID, we're on fire everywhere. So just hoping that you people, if you're listening and you're in some of those fire areas that everyone's staying safe, it's crazy times right now. And I'm looking forward to getting everything under control and seeing people safely be able to go out on an on the town again and sit down and have a nice dinner in a restaurant. So I think we're slowly getting there.

1:21
Last week, I was fortunate enough to get to spend a few days in Sedona, Arizona, with two of my sisters and my daughter to celebrate one of my sister's birthdays. And thank goodness their restaurants did have indoor seating, they're a little ahead of where we are in California because it was blazing hot out there. But the beauty, the relaxation, the excellent company, the pool of the hotel it made the heat just fine and everything good. And you know, it's really interesting as we age together, my sisters and I and our bodies and our conversations about life evolve. Sometimes there are real health challenges that are worrisome that happen amongst us and in our family. And they're difficult to deal with in my family, heart disease and its buddies high blood pressure and high cholesterol are major issues.

2:10
And for me, when I was diagnosed at 48 years old. With breast cancer, I had not ever had any problems in these areas of high blood pressure, high cholesterol, but after chemotherapy and tamoxifen and I had both high blood pressure in high cholesterol and fatty liver. I know that high cholesterol is a problem for a lot of women after treatment, so I wanted to talk about that today because there are some reasons why treatment can contribute to that.

2:40
And there are also misconceptions about how to control high cholesterol. So it's a multi-faceted issue, and this show isn't meant to treat the condition of high cholesterol, only to give you some insights that you can research further and discuss with your doctor if you think they apply to you some tips that might help you Have a healthier life.

3:01
So let's dig in.

3:03
So for many, many years, the public has been told that we need to limit dietary cholesterol. Remember when eggs were a big No, no, do not eat those eggs, right?

3:13
Well, the American Heart Association and the American College of Cardiology and the Dietary Guidelines for Americans have all backed off of their previous recommendations of limiting your dietary cholesterol intake to 300 milligrams a day or less. And I'll get into why that is in a minute.

3:31
But first, I want to give you a very simple definition of cholesterol, what the different types are, and why they're called good and bad. Then we'll talk about the evidence behind dietary cholesterol and the impact that some breast cancer treatments have on cholesterol levels. And why that is.

3:48
So first of all, cholesterol is a type of fat in your blood. This is we're talking about at the simplest form, that's referred to as serum cholesterol. And you can also eat foods that contain cholesterol. These are animal foods like meat, dairy, eggs, and that's dietary cholesterol; plant foods, including grains, do not have cholesterol in them.

4:09
So you're probably most familiar with good and bad cholesterol because that's what gets talked about all the time. So there's LDL, which is your low density labeled proteins, that's the one we call bad cholesterol. So think of a lipoprotein, like a little bubble. And the bubble is made of protein. And it carries fat and cholesterol around your body. Because our body is mostly water. And as you know, oil and water don't mix, right. So fat, oil, water, blood, so we have this little protein bubble that keeps the fat inside of it so it can go all around our body and do the work it needs to do.

4:46
So these little lipoproteins go around, and they drop off cholesterol in different places in your body. And that's way oversimplifying it, but I want you to get the picture, and this isn't a medical show, so we want to understand the very basic.

5:01
Cholesterol is made primarily in your liver. And LDL, the bad cholesterol, carries it from the liver to the other parts of your body, which is why it's called bad because it can collect in areas like your arteries and build up and cause plaque, which contributes to heart disease and that's bad.

5:20
Then we have our high-density lipoproteins are the HDL, which we call good cholesterol because a certain percentage of our good cholesterol can carry the bad cholesterol back to the liver, and the liver can break it down. That's why we call it good.

5:35
Now there's a lot more involved, and there triglycerides and very-low-density lipoproteins and intermediary lipoproteins. And we're just not going to talk about all that stuff. We're just going to talk about the very basics because this is not a medical show.

5:50
So let's talk about what contributes to having cholesterol in your body. We'll your liver and your intestines make most of the cholesterol in your body up to 80 percent, according to Harvard health publishing, and it does that for a good reason. Cholesterol is important for making vitamin D and hormones and bile acids in your body; we need some cholesterol.

6:11
But you know what they say too much of a good thing, right. And in this case, too much of a good thing increases your risk of heart disease and stroke, which is not good.

6:20
So when it comes to food or dietary cholesterol, an article published in the journal Circulation in December of 2019 said that both the American Heart Association in the American College of Cardiology determined that evidence from clinical studies was not sufficient enough to prove the dietary cholesterol or the cholesterol you eat in your foods raised the bad cholesterol, the low-density lipoproteins in your blood.

6:49
And they removed that recommendation that I refer to a minute ago of 300 milligrams a day or less of cholesterol because they decided that recommending an overall healthy eating pattern was more beneficial to public health than just telling people to limit cholesterol.

7:07
Now, this may seem weird to you, because if you're somebody who has tried to manage their diet in order to manage their cholesterol, and you've seen your cholesterol go up or go down depending on what you eat, you may be thinking, that does not make sense. I know what I eat affects my cholesterol. And some of you may think, yeah, you know, pretty much I can eat whatever I want to like my husband.

7:30
Holy cow, this man eats meat and cheese all day long, and it has no impact on his cholesterol whatsoever. So let's talk about why that happens. The National Lipid Association expert panel statement is that dietary cholesterol will cause a modest increase in cholesterol, specifically the bad cholesterol, low-density lipoproteins, but it notes that some of us will be hyper have more, or hypo have less response to dietary cholesterol.

8:00
So it doesn't have too much of an impact on some people. And it has a really big impact on others. That makes everything crystal clear, doesn't it? Yeah.

8:10
So basically, we're just saying that everyone is different, and some of us will respond differently to dietary cholesterol. And that's good to know. Because medicine net says that up to 30% of people are responders, meaning that dietary cholesterol will cause a spike in their blood cholesterol levels. So it's important to know your family history and how your body responds to food.

8:34
Now, I've heard many women say, what the heck is going on? I eat better than ever before since I have had cancer, and my cholesterol is still higher than ever.

8:44
So let's talk about a few reasons why that could happen, other than being caused by food. So some of the risk factors of high cholesterol are menopause, smoking, vaping diabetes, high blood pressure, unhealthy diet, sedentary lifestyle, and of course, genetics, family history.

9:06
Dr. Samia Mora, who is an associate professor of medicine at Harvard Medical School, and a specialist in cardiovascular medicine at the Brigham and Women's Hospital, Said in a May 2020 Harvard women's Healthwatch that drops in estrogen are associated with a rise in total cholesterol levels due to higher amounts of the bad cholesterol, LDL and triglycerides in our blood. And that postmenopausal women should be aware of that since cardiovascular disease is the number one cause of death for us postmenopausal women.

9:43
And you and I know that normally that would just be talking about age, right, postmenopausal age we think of someone in their 50s, but as breast cancer survivors, that's not necessarily true. When it comes to breast cancer survivors, women of any age can have and be in menopause because it can be chemically induced. So we need to be mindful of that. And if you're a young survivor, and you're in menopause, then you're dealing with this for a lot longer period of time. So it's good to be aware of what's impacting you.

10:15
Now, there was also a study published in the British Journal of cancer in 2005. And that study looked at a huge array of other studies that we're examining the effects of aromatase inhibitors on cholesterol levels. And what they found was that the impact on cholesterol was all over the board. Some studies showed that anastrozole had no effect on increasing cholesterol levels, while others showed that it was associated with a higher risk of high cholesterol than tamoxifen.

10:45
And still, another small study showed that anastrozole had a significant impact on increasing total cholesterol.

10:53
So the final conclusion in this study that looked at multiple other studies was that there was limited availability of data on aromatase inhibitors, but that exemestane has little effect, or might even be beneficial. And anastrozole has little effect or might have an adverse effect. And letrozole either has no effect or a detrimental effect. So are you guys glad that I'm clearing all this up for you? Right? The bottom line is, we're all different, and just like food impacts us differently, so do drugs.

11:31
So you have to know your body, and you have to work with your doctor to watch the responses in your blood when it comes to medications that are life-saving medications for you and when it comes to food.

11:45
Now on the bright side, because all that is really confusing and doesn't really give you any solid direction. But on the bright side, we do know that the higher your good cholesterol is, the better and that there are lifestyle modifications And certain foods that lower cholesterol.

12:04
So as far as lifestyle goes, exercise, regular exercise, which is medicine exercises, is a medicine; I cannot say that enough, not smoking and maintaining a healthy weight all lower your risk of having high cholesterol.

12:20
But what I think is really cool is how different foods work to lower your cholesterol. #letthyfoodbethymedicine.

12:30
So foods were going a couple of different ways to lower cholesterol. One is that certain foods have soluble fiber, and that's the kind that you can digest. The fiber is digestible, whereas insoluble fiber just builds bulk and moves right through you.

12:45
So soluble fiber is found in things like oats, beans, apples, peas, citrus, and other foods as well. That's not all-inclusive. Foods with soluble fiber actually stick their kind of gummy, and they stick to the cholesterol, and they take it out of your body, like roto-rooter. You know, eating oatmeal on a regular basis helps to move cholesterol out of your body, and that's very cool.

13:09
And for those of you who avoid grains or fruit, maybe follow a more ketogenic way of eating psyllium husk is also a great alternative. And you can blend psyllium husk and water and just drink it, which is so gross. And with my very sensitive gag reflex, I prefer to use it in cooking, but you can do it that way.

13:31
And psyllium husk actually works as a great ingredient in the crust if you follow this grain-free type of diet. So you can just google recipes for psyllium as an ingredient. And you know, when I first tried one of these, I found several recipes that contain psyllium husks on the diet doctor website, and the diet doctor website is a website that is low carb ketogenic, it's got all kinds of informative videos, and it also has a lot of really good recipes. I think every recipe I've tried from that website has been delicious.

14:05
But I found this recipe I think it was kind of like a quiche. I don't remember exactly what it was, but it had a crust and the crust, the main ingredient was psyllium husk, and I was really hesitant to try it because I thought this is gonna taste like sawdust. But I was pleasantly surprised, and it was actually very good.

14:24
So for those of you who don't eat grains or try to eliminate fruit or keep fruit at a very minimum in your diet, psyllium husk is also a good source of soluble fiber and insoluble fiber.

14:34
Such other foods like corn, wheat, nuts, and even foods that have been fortified, like chocolate and granola bars, they've been fortified with plant stanols or plant sterols, and that actually helps to block the absorption of cholesterol in your intestine. It's pretty cool.

14:56
Harvard health publishing says that you can lower your cholesterol by about 10% just by getting two grams of plant sterols or stanols in your diet a day. And I don't know very many women who would object to some stanol fortified chocolate to get two grams into their diet a day, so that shouldn't be too tough. Then there's also polyunsaturated oils like olive oil, canola oil, sunflower oil. And these oils polyunsaturated oils have a direct effect on lowering low density lipoproteins or bad cholesterol.

15:32
So even though the jury may be out on whether or not eating certain foods will increase your cholesterol levels, there's some pretty solid evidence that certain foods and supplements work to lower cholesterol levels. There's also a whole lot of supplements, but I don't want to talk about too many supplements because dealing with cholesterol can be a really serious issue and I don't want to encourage people to toy with that. You can also Google supplements that lower cholesterol and discuss them with your doctor.

16:03
So this is just another reason why eating a plant-based diet is becoming more and more popular and more and more recommended. And that does not mean you have to become a vegan or even vegetarian, even though the true definition of plant-based eating is to exclude all animal foods from your diet.

16:22
But if you're not ready for that, as many people are not, it's okay. Just keep adding more plant foods into your diet. Have a salad every day, or work up to having half a plate full of veggies with your meals. Something that I recommend all the time is to buy a vegan cookbook or a vegetarian cookbook and try some of the recipes in it.

16:44
Just try to keep an open mind and be curious about ways of preparing delicious plant foods because there are so many ways now. If you go on Amazon, and you look up vegan cookbooks, it is not going to be the Nuts and seeds, and I don't know weird stuff from the 1970s to the 1980s. We used to see, when people didn't eat meat, there's a really great cookbook out there. And so even though I'm not a vegan, I have a large collection of vegan cookbooks, which have helped me learn tons of ways to prepare plant-based foods and to eliminate dairy from my diet, which has had a big impact on my cholesterol levels of positive impact.

17:27
So the bottom line is, don't beat yourself up for having high cholesterol, or just thinking that it comes from what you put in your mouth. And maybe rather than worrying about what foods increased cholesterol, start looking at the bigger picture of what lifestyle habits lower cholesterol, and what lifestyle habits leave you feeling more energetic and healthy. You know, sometimes I feel like we get so stuck in the I can't, I can't have that...I can't do this... I can't eat that... Or I have to eat only these things......

18:00
To me, that's just kind of a punitive way of approaching life. And I'm not big on punitive.

18:06
Rather, I would suggest that you open yourself to the possibilities of all the new possibilities of all the exciting and delicious things you can do, and you can enjoy to support your health.

18:20
So good health is not about deprivation or fear of everything or I can't, I can't, I can't. It's about joy and balance and variety and understanding how your unique and amazing body works.

18:35
So get curious and be kind to your body. If it's not producing the bloodwork, you want to see what you can do to help it get there. Ask yourself that. And that includes speaking with your doctor about medicinal support if that's what you need, and sometimes that is needed, and it's okay, it's perfectly okay.

18:55
The most important thing to be kind to yourself and don't judge your body. You've been through enough tough stuff already. Give yourself a break and take what you need. Now, I'd love to hear your thoughts on how you manage the side effects or the effects of your treatment.

19:13
So please come and join in that conversation with us in the breast cancer recovery group on Facebook. You can search it on Facebook, or go to the show notes for this episode, which you can find at thebreastcancerrecoverycoach.com/104, and you'll find the link to that group and to the studies that I refer to in this show as well.

19:34
And I also want to remind you to keep listening for announcements for the newly added October Revivify enrollment. I'm really really excited about this. I really believe this support is needed now more than ever, and I usually don't do Revivify's back to back because there's a lot goes into it a lot of work and energy, but I love it, and I really, really think it's needed.

19:58
And if you want to get a Jump Start, you can go to my website and join the breast cancer recovery course; when you enroll in that, you get some lessons that are straight out every Revivify. But you can get started if you feel like you need something now, and the entire cost of that program goes towards your enrollment in Revivify. So it's a pretty cool deal.

20:18
All right. Well, I thank you for listening. I hope that if you're dealing with high cholesterol, that has given you a little bit of insight, and hopefully, the different shifts that you can approach managing that condition. I don't know with a little more of an open mind and not so much fear and feeling frightened by everything that you put in your mouth. There's lots of different options and ways that we can control what's going on or at least support what's going on inside of our bodies.

20:45
So thanks for listening, and I really appreciate it if you have the time; it would mean the world to me. If you go wherever it is that you listen to podcasts, go to the iTunes Store, leave a rating, leave a review, it really really really helps the show tremendously. It means the world to me. All right. So I will talk to you again next week and until then, be good to yourself.

Transcribed by https://otter.ai