Conquering Cholesterol

Her patients are most successful when they implement changes in small increments over time. Some give up fast-food lunches. Or they set a goal of packing their lunch two days per week. “It’s about really trying to make it manageable,” Lawler says.

Contagious Improvements

Hoaglund had been a record-setting sprinter in high school and ran an average of 75 miles a week from the time he was 19 until he was 25. But then his exercise slowly decreased. “I had been very fit and strong once, and wanted that comfortable and confident feeling to return,” he says. Running and training did that.

“Exercise is sort of the answer for a lot of what ails us,” Ketroser says. “It repairs your arteries, it increases your HDL [good] cholesterol, it lowers your LDL [bad] cholesterol, it makes you feel better, it decreases depression. Doing 30 minutes of walking or biking or swimming every other day seems to make people live longer and feel better. There is a mantra you have to tell yourself: ‘This is necessary to be well.’”

Ketroser says that once people get past their initial resistance, he’s seen them gain momentum—they don’t want to erase the benefits of a new good habit by continuing with past bad ones. Hoaglund is living proof. “When I decided to restart running, my diet changed radically, but almost by itself. I now experience absolutely no cravings for fries or burgers or ice cream. However, I often crave fruit or nuts or fish. This doesn’t feel like a conscious thing to me—it’s almost just a part of the rest of the changes created by returning to an active lifestyle,” he says. 

Even after implementing diet and exercise changes, some people still have problems lowering their cholesterol numbers. Here’s where Hoaglund’s genetic “bad luck” continued. “I run 30 to 50 miles per week, bike about the same amount, visit a personal trainer twice a week for strength training, and go to the gym each week,” Hoaglund says. “My diet is well controlled. At the very best, I could tweak my [cholesterol] readings down to 280. Losing 60 pounds and improving my lifestyle immensely did not change my cholesterol numbers at all.”

He finally turned to medication, and the efforts he’d already made to reduce his cholesterol made him a good candidate, in Ketroser’s view: “Whatever we do with medications, it’s all predicated on the fact that we’re also talking about lifestyle changes. And that includes a low-fat diet, aerobic exercise, not smoking, maintaining a normal blood pressure. We use medications only in those cases where the patient’s genetics dictate that we aren’t going to get to where we need to be by diet, exercise, and risk-factor modification.”

There are potential side effects with these powerful medications. Hoaglund had to try three drugs before he found one his body could tolerate. The first two caused muscle pain and interfered with his liver function.

With five half-marathons and six marathons under his belt, he’s kept his weight at 200 pounds. He dropped six inches off his waist and, with medication, finally lowered his cholesterol to under 170. “I won’t trade this for anything, ever again,” Hoaglund says.