High cholesterol contributes to “atherosclerosis” - a type of arteriosclerosis. In arteriosclerosis - which means “hardening of the arteries,” the lining of the arteries becomes damaged. Deposits of fibrous tissue, calcium, and cholesterol form plaques, which narrow the diameter of the arteries. This limits the flow of blood through that artery, and reduces blood flow to the heart, brain, and legs. Clots can form at these plaque sites, or pieces of the plaque break off. In both cases, an artery can become completely blocked leading to heart attack or stroke. Cholesterol in the bloodstream combines with proteins to form lipoproteins, including high density lipoprotein (HDL) and low density lipoprotein (LDL). HDL is actually beneficial (think of H for healthy), and may help pull cholesterol from the plaques in the arteries. LDL (think of L for lethal) is the dangerous component, and when it becomes oxidized, may cause or accelerate arteriosclerosis. Triglycerides are another category of fat within the blood stream which also contribute to cardiovascular disease when elevated. Testing is done with a lipid profile blood test after a 14 hour overnight fast. Although cholesterol is not affected by fasting, triglyceride levels are. The test gives us values for total cholesterol, HDL, LDL, triglycerides, and a ratio between total cholesterol and HDL. This risk ratio is an indication of tendency toward cardiovascular disease. We can also test for other cardiovascular risks such as homocysteine, C Reactive Protein (CRP), and carotid intima media thickness (IMT).
IMT assessment is done with an ultrasound which measures the thickness of one of the layers of the carotid artery in your neck. This is actually a measurement of arteriosclerosis. While other risk assessments try to predict how likely you are to develop atherosclerosis, IMT test measures how much arteriosclerosis you actually have accumulated. IMT assessment also tells us if there is plaque in the carotid artery. We do this test in our office once a month. There are a variety of other tests for risk factors that can also be done. These, in our opinion, are of less value and add more cost. In some cases, you may choose to do these tests. These tests include measuring levels of anti-oxidant nutrients, levels of oxidative compounds in the blood stream, looking at other lipids like Apolipoprotein A, Apolipoprotein B, and testing fractions of LDA and HDL, which may give more predictive value.
Treatment for high cholesterol is important to reduce your chance of developing atherosclerosis. Treatment includes the following components:
Diet is very important, but is more complex than avoiding cholesterol in the diet. Some people do best with a strict low fat diet like a Pritikin or McDougal diet program. Other people do better with a moderate diet (like the Zone diet) or a low carbohydrate diet like the Atkins' diet. Those with Syndrome X, also called Metabolic Syndrome do much better with a low carbohydrate diet, like the Atkin diet or others which aren’t as extreme. You have metabolic syndrome if you have trunkal obesity (obesity mainly around your waist), high blood pressure, insulin resistance (leads to diabetes), high cholesterol and/or high triglycerides. You may have to experiment to see which diet serves you best in terms of how you feel and what happens with your lipids. Basic to any healthy diet is eliminating or severely restricting refined white flour and sugar. Reduce animal fats and hydrogenated vegetable oils, and include more fish oils, and healthy plant oils, like olive oil, and cold-pressed oils.
Exercise is important to raise HDL. When done regularly, it will increase your fitness level, which in turn will help offset the risks of elevated cholesterol and other risk factors. It will also encourage the development of collateral arteries in the heart to prevent heart attacks.
Weight loss is important for those who are overweight if it is done in a healthy fashion. Starving weight off will only be temporary and is usually followed by weight gain to a higher level than ever. Healthy eating with elimination of sugars and good exercise almost always helps.
Natural products that lower cholesterol are now available, which sometimes work even better than the drug approach. Tocotrienol is a vitamin E derivative. Take 1 or 2 daily with meal. Polycosanol (cane sugar derivative) 10 mg. capsules, take 1 or 2 daily. May increase HDL. Red Rice Yeast Extract has similar active agents as in statin drugs. It is natural and less expensive. Chitosan (shellfish chitin) in powdered form binds to cholesterol preventing re-uptake from the intestines. Niacin, a B vitamin, can also lower cholesterol and triglycerides, but needs to be taken in large amounts. You will generally need 500 mg to 2000 mg daily. It may cause very unpleasant flushing. Start with smaller amounts, take with food to delay absorption, divide the product into 2 to 4 daily doses, and build up the dose slowly. Fish oil also lowers triglycerides, and sometimes cholesterol. It also helps reduce inappropriate clotting, and is highly recommended for anyone with cardiovascular risk. Take 2-6 capsules daily.
Reduce Oxidation of LDL. LDL is only a problem when it becomes oxidized, then it acts as a “free radical”, causing damage to the lining of the artery, thus initiating or worsening arteriosclerosis. “Antioxidant” nutrients may reduce this damaging process. Most fresh fruit and whole vegetables have a variety of anti oxidant compounds. Wheat germ (found in whole wheat products but removed from refined white flour) has good antioxidants including vitamin E. Various antioxidants can be found in supplemental nutrients. Vitamin C, E, and Beta Carotene are among the best known antioxidants.
Reduce other cardiovascular risk factors like high blood pressure, smoking, elevated homocysteine, excess weight, and elevated C reactive protein (CRP). Homocysteine is a metabolic by-product strongly linked to arteriosclerosis, the higher the level, the higher the risk. It can be lowered with Folic Acid (a B-vitamin), vitamin B6, and vitamin B12. These need to be taken in higher doses to be effective. CRP responds to antioxidant nutrients. A high potency multiple vitamin/mineral supplement should contain good levels of these B vitamins, antioxidants. Prime multiple is ideal.
Drug therapy may be indicated if lipids are not controlled with more natural means. The statin drugs such as Lipitor and Zocor are the most popular. They may have unpleasant side effects and they do interfere with the absorption of fat soluble vitamins and co-enzyme Q10, so those nutrients should be supplemented while taking these drugs. After taking medications for 2-3 months, the lipid profile should be rechecked. If control is inadequate, dosage may need to be increased.