About 11 months ago, my three year old son’s doctor did a random blood check, and we found out he had high cholesterol. At this time, the doctor did not do anything. About eight months later, we had a fasting blood cholesterol drawn, and it was higher (236 mg/dl). He is too young for medicine which I would have not wanted to put him on medicine until we tried to control it with a diet.

I need help finding what he can eat at this age. He only drinks milk and water. The doctor said that I could give him skim milk and should not give him anything more then 1%. He also told me to keep away from fatty foods. What does this include? Can he still have all fruit and vegetables even if they have fat in them? Should I cut back on peanut butter (now only once a week)? We do not cook with grease. The only fried food we get is when we go out to eat! Does high cholesterol cause other things to happen later in life? How high can it get before we worry about him playing outside in the heat and having a heart attack?

Cholesterol is not always a “bad” thing. We need cholesterol in some fashion as it is the basis of several important things including integrity of our cells, the manufacture of Vitamin D and some important hormones such as hydrocortisone (cortisol) which is essential for life. Cholesterol is also the biochemical basis of the hormones of puberty: testosterone and estrogen.

There are 2 major categories of cholesterol that circulates in the blood: one is called “HDL-cholesterol” and the other is “LDL-cholesterol.” HDL-cholesterol is heart protective! (I joke that that “H” stands for “happy.”) LDL-cholesterol is bad for hearts. (I suggest to families that the “L” stands for “lousy.”)

So before I would get too concerned about your son’s cholesterol, his doctor should do (and probably already has done) a “lipid profile”, through which the various types of cholesterol can be analyzed. If the majority of that 236 value was HDL-cholesterol, I would not be worried. Cholesterol levels need not be done fasting, but a component of the circulating fats in the blood are called triglycerides, which are measured in the lipid profile also, are optimally measured while fasting (think of them as tiny fat droplets–yuck!).

Things to consider:

Is there a family history of early heart attacks and strokes?
How often you go out to eat?
White meat has less cholesterol than dark meat.
The skin of chicken and turkey has more cholesterol.

Even under the best of circumstances, with terrific attention to diet and exercise, these maneuvers often will only bring down the cholesterol by 10-15%. If there is a strong family history, then cholesterol lowering drugs may be in the future, depending on the lipid profiles. A particular cholesterol lowering drug is safe and well studied in children. It “binds up” cholesterol in the intestine and inhibits it from being absorbed into the bloodstream. These cholesterol-binders commonly lead to changes in the bowel pattern.

Talk with your son’s doctor and ask for a referral to a registered dietitian who has experience working with children.

DS
Additional comments from Dr. Donough O’Brien:

Ask about testing was done for other causes of elevated lipids, such as hypothyroidism.

DOB