High cholesterol no cause for worry?

Q. I am a 24-year-old female. I'm a normal weight (5'7", 133 lbs). I work out at least 5 days per week. I  avoid all processed food and generally try to fill my days with whole grains, veggies, fruits and non-fat dairy sources. I usually have a small amount of caffeine in the mornings, I don't smoke, and I drink two or three times per month. All in all, I think I lead a pretty healthy lifestyle. However, I went to my doctor last week and was surprised to find that my cholesterol is slightly high (more than 200 mg/dL). I don't have a family history of high cholesterol or heart disease.  Is this a common problem in people who lead otherwise healthy lifestyles? I'm hoping to avoid taking prescription meds for the rest of my life.

A. I think it's a little soon to be thinking about prescription meds for life!!  Given all you've reported here, you may not have anything to worry about.  For one thing, high cholesterol does not mean you have (or will develop) heart disease.  Although elevated cholesterol is statistically linked to a higher incidence of heart disease, many people who die of heart disease have normal cholesterol...and many people with elevated cholesterol never get heart disease.  Cholesterol tests are screening tools, not diagnostic ones.

Cholesterol is only one piece in a larger picture. Given the rest of the details you've given (normal weight, not sedentary, no family history of heart disease or high cholesterol, normal blood pressure), your statistical risk of developing heart disease in the next ten years is extremely small. 

I'm also wondering about the details of your cholesterol--specifically about the break-down of HDL ("good") and LDL ("bad") cholesterol.  Your total cholesterol may be high because your HDL is high, thanks to all your healthy habits.   I would think before prescribing medication, your doctor would follow up with a more comprehensive lipid panel. I'd give even odds that a retest would show normal cholesterol, anyway. The slightly high reading may well have been an anomaly.

Finally, it sounds as if your diet is very low in fat and fairly high in carbohydrates.  If you wanted to see if dietary modifications might nudge your cholesterol numbers in the right direction (although, again, I'm not sure you really have that much to worry about), you might try adjusting the balance of your diet to be a little higher in fat and lower in carbs, particularly grains. Olives, olive oil, almonds, and avocados (all rich in monounsaturated fats) would be good choices.

Let us know what happens next.