The Cholesterol Paradox in Elite Athletes
The relationship between high athletic performance and cholesterol levels presents a perplexing anomaly for athletes. Despite rigorous training regimens and seemingly healthy lifestyles, many exhibit elevated cholesterol levels, leading to the phenomenon known as the “athlete’s paradox”. Numerous theories have been proposed to explain this connection and aim to elucidate why some of the fittest individuals can still struggle with high cholesterol levels.
Cholesterol Explained
Cholesterol is a waxy, fat-like substance that is essential to the body, as it produces hormones, vitamin D, and substances that aid in digesting fats. When we think of cholesterol, we generally think of the two main types: LDL, which is notoriously known as the “bad” cholesterol, and HDL, known as the “good” cholesterol. Elevated LDL levels have shown to lead to plaque buildup in the arteries, increasing the risk for cardiac complications, whereas HDL works to clear LDL out of our blood. Together, HDL and LDL are two key components of total cholesterol.
Diet and the Liver Pool
Diet is a significant modifiable risk factor that can greatly influence cholesterol levels, and this remains true even for athletes. Research indicates that high-performing athletes, like ultra-endurance runners, who adopt a low-carbohydrate diet generally compensate with higher fat intake, an obvious mechanism leading to elevated total cholesterol levels (Varma, 2022). While these ketogenic-like diets are not necessarily ideal, nor common, among this population due to high energy demands, the athlete paradox can still occur in the presence of other diets, perhaps driven by other mechanisms we’ll explore in later sections.
High-performing athletes also exhibit an increased demand for lipid metabolism as a result of their accelerated rates of fatty acid oxidation (Creighton et al., 2018). In simpler terms, these athletes require more energy from fats because they burn it at a much faster rate during their training. This increased metabolic activity necessitates an expansion of the intravascular cholesterol pool to support energy production and performance, meaning that their bodies require more cholesterol in the bloodstream to support optimal athletic performance.
This relationship highlights the complexity of nutrition in athletic performance and presents a call-to-action for athletes to carefully consider how dietary choices can influence cholesterol and overall health.
High Performance, HDL, and Lipoprotein
A common assumption stands that regular exercise would lead to lower cholesterol levels – makes sense, right? That said, it’s important to remember that total blood cholesterol include both LDL and HDL. Research shows that aerobic exercise actually increases HDL levels, significantly influencing total blood cholesterol. This suggests that while total cholesterol might remain elevated, the balance shifts in favor of the “good” cholesterol. This rise in HDL levels as a result of aerobic training is associated with an increase in the expression of lipoprotein lipase in skeletal muscle, an enzyme that is crucial for HDL production in the body. After exercise, lipoprotein lipase accelerates the breakdown of triglycerides, transferring cholesterol to HDL (Greiwe et al., 2000). This relationship is somewhat ironic, showing that total cholesterol can increase as a result of an increase in the “good” cholesterol. Thus, while high-performing athletes may observe a rise in total cholesterol levels, it may be primarily driven by an increase in HDL.
The connection linking high performance exercise, elevated cholesterol, and lipoprotein is further represented in research by explaining the underlying mechanism driven by lipoprotein (a). For example, increased lipoprotein plasma concentration may actually be a normal metabolic response to the repeated small tissue injuries high performance athletes endure as a result of prolonged muscle movement, which is common in endurance sports (Nystoriak & Bhatnagar, 2018). One study expands on this theory by offering that athletes who train daily tend to exhibit higher lipoprotein (a) concentrations, specifically, which is a type of LDL that carry cholesterol to the cells housed in the arteries. While this would generally be alarming, further research recognizes that you do, in fact, need a certain amount of LDL to gain more muscle mass, perhaps explaining this phenomenon.
The Connection to Muscle Mass
Another theory to explain the athlete paradox is rooted in a connection to muscle mass. Interestingly, one study found that people with both the highest muscle mass and highest fat mass had the highest total cholesterol levels, further highlighting a complicated relationship (Gao et al, 2022). These findings may be explained by the fact that cholesterol play a crucial role as a building block for anabolic hormones, helping to create the proteins needed to build muscle. Plus, we’ve already mentioned that this high-performance training can result in increased HDL levels and cause an elevated total cholesterol reading. Nevertheless, the research connecting muscle mass to cholesterol levels remains limited and further exploration is warranted to gain a better understanding.
Training Adaptations
Training adaptations to prolonged, intense exercise may also explain this paradox, as they can also lead to increase cholesterol. These rigorous training regimens result in increased oxidative stress by producing more reactive oxygen species (Pinckard et al., 2019). These can result in damage to cell membranes and contribute to inflammation, potentially influencing cholesterol metabolism. With that, prolonged exercise generally results in muscle damage as part of the muscle-building process; however, this, again, can trigger inflammatory responses and impact cholesterol levels (Nystoriak & Bhatnagar, 2018). Hormonal changes are without a doubt inevitable with this type of exercise intensity. Temporary spikes in hormones, like cortisol, can potentially increase cholesterol synthesis in the liver. Together these factors present a complex interplay that can contribute to the athlete paradox.
Recommendations to Fight High Cholesterol
Proper nutrition is critical for high-performing athletes, directly impacting their energy levels, recovery, and overall performance. That said, implementing smart nutritional strategies can help combat the athlete paradox of high cholesterol.
Increase omega-3 fatty acids: incorporate sources of unsaturated fats, like fatty fish, flaxseeds, and walnuts, to support HDL and reduce LDL.
Focus on fiber: a diet rich in soluble fiber can help to lower LDL levels by binding to cholesterol and helping to remove it from the body. Oats, beans, and fruits are great sources of soluble fiber.
Lean on lean proteins: opt for leans means, like chicken, turkey, and fish, that contain less saturated fat compared to fatty cuts of meats.
Emphasize healthy fats: foods such as avocados, nuts, seeds, and olive oil contain monounsaturated and polyunsaturated fats, which are beneficial for hearth health. Healthy fats can help to improve lipid profiles by helping to reduce LDL and increasing HDL.
Blueberry Protein Overnight Oats
Servings: 4 Prep Time: 8 mins
Ingredients:
1 cup frozen blueberries
1 Medjool date pitted
2 cups rolled oats
2 scoop unflavored protein powder
2 tablespoons coconut shreds
½ teaspoon cinnamon
A pinch of salt
2 cups water
¼ cup instant oats
2 tablespoons chia seeds
Directions:
In a blender, combine the frozen blueberries, pitted Medjool date, rolled oats, unflavored protein powder, coconut shreds, cinnamon, a pinch of salt, and water. Blend until you have a smooth, naturally sweet blueberry mixture.
Add to rolled oats along with instant oats and chia seeds. Mix evenly.
Seal the containers tightly and place them in the refrigerator. Allow the oats to refrigerate for at least 4 hours, or preferably overnight. This will give them time to absorb the liquid and thicken.
The next morning, give the oats a good stir. You can adjust the consistency by adding a bit more milk if desired.
Feel free to customize your oats with additional toppings like sliced almonds, a drizzle of honey, or a dollop of yogurt for extra flavor and texture.
The athlete paradox of high-performing athletes and elevated cholesterol levels presents an intriguing, yet complex, picture. We’ve explored the role of various factors, from diet to muscle mass, and it’s clear that multiple mechanisms may be in play for this phenomenon. As these athletes continue to push their bodies to the limit, cholesterol levels might not follow the expected trends associated with health; however, with so many different variables involved, further research is necessary to fully understand these connections and implications of elevated cholesterol levels.