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Cholesterol: What You Should Know

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I’m opening with a bold statement: In over 15 years in practice, I’ve never worked with anyone willing to do what was required to lower their high cholesterol level who was not successful. This includes people who were told their high cholesterol level was genetic and that dietary changes would not help. This is not to say it’s easy. Change, of course, never is. But it is doable. And notice I did say it requires a willingness to do what is required. Many of these clients have brought their cholesterol level back into balance with only changing diet and exercise. Some have required help from supplements or herbs in addition to changes in their diet.

In my many years of practice, I’ve also heard numerous people say they tried lowering their cholesterol through dietary changes, but without success. However, the conventional wisdom for dietary changes requires lowering the fat in the diet to minimal levels. A fat-free, or very low fat diet is not what I recommend. And, for roughly 25% of the population it will actually make things worse. I’ve also heard people say they’ve tried supplements and they didn’t work either. However, supplements in the form of vitamins, minerals and herbs are not drugs and do not act like drugs. They are “supplements” which means, they work effectively in conjunction with a healthy diet and lifestyle. Just taking a supplement alone, without changing poor diet habits will generally not work.

My usual recommendation is we first start with diet and exercise for a short trial and re-check levels. If we don’t get the results we want, then we try one of a variety of helpful supplements, for additional support. The supplements that may help are very individualized based on what your numbers are and other health concerns and symptoms. For example, a high triglyceride (above 100) would require a very different approach than a high LDL cholesterol, or high CRP. That’s why it’s important to have a specific approach based on your individual chemistry. A trial should be planned, documented and tested.

I believe far too many people receive prescriptions for statin drugs and other cholesterol-lowering medications. Often they’re being told their numbers won’t come back into balance without them. It’s critical to remember, however, these drugs have many side effects, some very serious, like fatigue, muscle pain and muscle weakness. Some of these side effects are not reversible when the drug is stopped. As always, I believe everyone should have all the facts before deciding to take medication.

Let me first address the statistics with statin drugs. Please note I’m stating the statistics in preventing a heart incident in people who have not had a previous incident. The pharmaceutical industry uses the statistic that these drugs decrease risk of a cardiac incident by 37%, or more. Let me explain what that means in real numbers. In a British study on lipitor, there were 1.5 cardiovascular events per 100 people taking statin drugs compared to 2.4 incidents per 100 people taking a placebo. That means that a heart incident was prevented in less than one person (0.9) per hundred taking these drugs. Yet, 10 out of 100 experience adverse reactions to these drugs. A change from 2.4 to 1.5 represents a 37% decrease in incidents.

There is also no evidence that women have any decreased risk at all from studies (recent study results reported in Lancet 1/07). And for men over 67, 100 men need to be on them for 5 years to see this decrease of 1 incident per 100 men. The stats may look more promising for people who are taking statins who have had a previous cardiovascular event.

When it comes to prevention, there is little evidence that these drugs are that beneficial. Even NIH (National Institutes of Health) recommendations are that the first line of therapy should be 12 weeks of lifestyle approaches before drugs. Only then, if this doesn’t work, are drugs recommended. Yes, these are the current NIH recommendations.

The pharmaceutical approach is generally focused on lowering cholesterol. But high cholesterol alone may not necessarily increase risk. High cholesterol is just one factor. It’s actually oxidized cholesterol that leads to plaque formation in the blood vessels. And that process occurs due to many factors. Increased inflammation, increased oxidation, high blood sugar levels, hormonal imbalance, high insulin levels, and high fibrinogen levels to name a few. And, most of these other factors, if out of balance, have nutritional, not pharmaceutical solutions.

Lowering cholesterol levels in a vacuum, without looking at all the other factors, is like pulling the plug to disconnect the oil light in your car. The indicator light is a warning signal that the oil may be low. A high cholesterol level is also a warning signal of a body out of balance, but far from the whole picture. Lowering the cholesterol may be just like turning off the oil indicator warning light, and a false sense of security. Even President Clinton had a healthy cholesterol level of 179 when he had emergency surgery for clogged arteries. There is much more to this picture.

My suggestion before taking medications is to get the following tests: CRP, homocysteine, fibrinogen, lipoprotein a, lipid panel, fasting blood sugar and insulin, and TSH. If the lipid panel indicates high cholesterol, then I recommend a VAP test, which breaks down the good (HDL) and bad (LDL) cholesterol further, to determine how good your HDL actually is and how dangerous the type of LDL you have is. Only after getting all these tests can a proper assessment be made.

And, don’t settle for what the lab calls normal. I’m guessing you want low risk levels not normal risk. Also, it’s important to note that often the research is ahead of what is reported as normal levels by the labs.

Then, bring your lab work in and we’ll get you started on a program to get back into balance. Finally, let me request that you send this article to your family and friends. I’ll stand firmly behind the bold statement I made up front in this article: If you or others are willing to work on this important issue, I’ll do all that I can to ensure success, a success I’ve seen over and over again. Let’s get started.