Dr.Garber’s Blog

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Well, you’ve been asking and here it is - the third and final installment of my series on cholesterol. So far in this series I’ve discussed  the different types of cholesterol as well as some of the other fats that are found in the blood. I’ve also discussed the factors that cause inflammation in the blood vessels, the real culprit in this saga. In this post I will let you know what you can do about it all, also what I feel you should not do, and why.

I’ll get the “what I feel you should not do” part, the Ugly in the title, out of the way first so the remainder of the post can stay positive and proactive. But this area is no less important. If you’ve been reading my blog posts you probably already know that I’m referring here to the statin drugs - Lipitor, Mevacor, Zocor, Crestor, etc.

All drugs produce side effects. These side effects can be quite severe, sometimes fatal, and the statins are no exception. All doctors know this and the question always is, or should always be, what is the benefit of a given drug versus the harm. A big problem is that most doctors, whether they are conscious of it or not, tend to minimize the harm from the drugs they are prescribing because, for the most part, prescribing drugs is what they do to treat their patients. A very interesting Washington Post article clearly illustrates this curious phenomenon.

The most common side effects of statins are muscle pain and muscle weakness. The muscle symptoms are a result of the drug causing a breakdown of muscle fibers, called  rhabdomyolysis, which the body must then eliminate. In excess, this can overload the kidneys, resulting in kidney failure. One cholesterol lowering drug, Baycol, has already been taken off the market because so many people taking it died as a result. Other side effects produced by statins are liver damage, digestive problems (nausea, diarrhea, constipation,) neurological problems such as peripheral neuropathy and even memory loss.

Since these drugs are the top selling pharmaceuticals (Lipitor has been the #1 selling drug in the world for the last five or six years) you may be wondering how is that possible if they’re so bad. What does Garber know that all these doctors who are prescribing statins don’t know? The sad but true answer to this question is that ad campaigns that extol the benefits of drugs are, unfortunately, more powerful than education about side effects. Early on in their history, studies were done done that showed the cholesterol lowering effect of statins reduced the risk of heart attack and stroke. Many of the studies were sponsored by the pharmaceutical companies that made the drugs, others weren’t, but no expense was spared on the part of the makers to capitalize on those positive findings. The result of that effort has been clearly evidenced by statin’s wild popularity. However, more recent studies involving much larger patient populations over a much longer time period have shown that this is not necessarily the case. There are some benefits provided by statins, this is not in dispute. But as the benefit to risk ratio continues to decrease one must really consider the alternatives, especially when there are so many that work so well. I urge you to click on the above links and see these studies for yourselves.

Before I start discussing what you should take instead of statins I want to discuss lifestyle changes, as these are without a doubt the most important actions you can take to improve your cardiovascular health. First and foremost, if you smoke - STOP! I know it’s not easy (yes, I am an ex-smoker) and I’m not going to try to make any of you feel guilty. It’s just a fact that the single most important risk factor for cardiovascular disease is cigarette smoke.

Next comes diet and exercise - but you already knew that, didn’t you? Taking a pill may be easier, another reason pharmaceuticals have taken such a hold over us, but making lifestyle changes is so much more empowering. Of course there’s no one diet that is right for everyone but when it comes to cardiovascular health there are certain rules of thumb that do apply to everyone and have a positive effect on almost all the different blood fats. These include increasing the amount of fresh fruits and vegetables and reducing the amount of animal protein in your diet, much along the lines of what is known as the Mediterranean Diet, and eliminate, as much as possible, trans fats from your diet. Trans fats are fats that are created by the addition of hydrogen to liquid fats (look for ‘partially hydrogenated’ on the label) to make them solid. They behave much like saturated fats in that they tend to increase the bad (LDL) cholesterol and decrease the good (HDL) cholesterol. Fortunately they are fairly easy to eliminate from the diet because they are mainly used in foods you already know to be unhealthy: cakes, cookies, crackers, margarine and other shortenings, potato chips, in fact, most packaged foods. As for exercise, it depends on where you’re starting from. The important thing is to do more today than you did yesterday, and do some sort of exercise every day. If you’re leading a basically sedentary lifestyle, as most people do, don’t decide that you need to start training for a triathlon. There’s a wonderful movement afoot (pun intended) called the 10,000 Steps. This program is very easy to incorporate and will improve not only the cardiovascular system but also conditions like type-2 diabetes.

If your blood fat picture is such that following all the above is just not enough to do the trick, or needs more of a boost while you are starting to make these lifestyle changes, there are nutritional supplements that are readily available that can help. As I said in earlier posts, it’s not so much to the total amount of cholesterol but it is the ratio of the good to the bad. The omega-3 fatty acids, as are found in fish oil, will increase HDL and also decrease triglycerides. Fish oil supplements have so many other beneficial properties that I recommend them to just about all my patients. Remember from part 2 of this series that I said that the real culprits in this blood fat story are the factors in the blood that produce inflammation in the blood vessels. Fish oil has an anti-inflammatory effect, reversing some of the effect of c-reactive protein and decreases the levels of homocysteine in the blood, both leading causes of blood vessel inflammation. Homocysteine levels are also modulated by Vitamin B-6, B-12 and Folic Acid. Adding soluble fiber to the diet, as food (preferably) or as a supplement, will also help decrease triglyceride levels and LDL cholesterol levels. Certain constituents found in red wine, called phenolic antioxidants, have been found to increase HDL cholesterol, keep LDL cholesterol from forming and reduce blood clot formation. If you don’t drink alcohol, these are also available in supplement form.

I hope this three part series on cholesterol has given you some helpful information on a complex subject and some useful tools to help you improve your health without the dangerous side effects of pharmaceuticals.

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In the first part of this series I discussed a bit about cholesterol in general, how important cholesterol is to health and the fact that high cholesterol, in and of itself, is not necessarily bad. I want to touch briefly now on the different types of blood fats (lipids.) By now pretty much everyone has heard about “good” cholesterol and “bad” cholesterol. Well, it’s not quite as simple as just good versus bad but for our purpose here let’s use those terms. The so-called “good” cholesterol is HDL, which stands for “high density lipoprotein” and the so-called “bad” cholesterol is LDL, which stands for low density lipoprotein. A lipoprotein is simply a molecule that contains a fat and a protein together and it is in this form that fats move around through the blood stream. There are several other lipoproteins besides HDL and LDL, which is why, if you have a blood test that measures HDL and LDL as well as the total amount of cholesterol, the numbers don’t add up. It’s these other lipoproteins that make up the difference. As with everything in the body, it’s really about balance. So it’s not so much the absolute amount of these fats that’s important as it is the ratio. What we want is the HDL to be higher and the LDL to be lower, relative to the total amount of cholesterol. The lower the ratio of LDL to total cholesterol, the lower your relative risk of cardiovascular disease.

Another important class of lipids, called triglycerides, also play a role in cardiovascular health. Triglycerides are where the energy from food goes when you take in more calories than you need at the time. It is different than cholesterol and can be high when your cholesterol level is normal or even low. High triglycerides can play a significant, and independent, role in the production of cardiovascular disease.

As I mentioned in part 1 of this series, the real culprits that allow high cholesterol levels to become problematic are factors found in the blood that create inflammation and damage the inside of the blood vessels. It is when the lining of the blood vessels are damaged in this way that excess cholesterol may accumulate and form the plaques that can block blood flow. The two most important of these factors that I look at are homocysteine and C-reactive protein, often abbreviated as CRP.

Coming up in the third and final installment of this series I will tell you why I feel that statins, the drugs that are prescribed to reduce cholesterol, are harmful and how you can bring your lipid profile into a healthy balance through dietary and lifestyle changes and specific nutritional supplementation.

When I first began in practice, the laboratory “normal” result for cholesterol was reported as a range and, depending on the lab, was (plus or minus) 150-300 mg/dL. Over time that range kept creeping lower until the range was eliminated and the “desired” level was anything less than 200. Now I’m no conspiracy theorist but I have to say that each lowering of the “normal” levels for cholesterol strangely coincided with the release of some new drug for lowering cholesterol. I know of one lab now that has started reporting cholesterol as a range again and they are using 125-200 as a reference.

Now, in my 28th year of clinical practice, I can say without hesitation that the sickest patients I have ever encountered were those with very low cholesterol. When there’s too little cholesterol your immune system begins to break down, nerves can’t transmit their signals properly, sex hormones can’t be manufactured in sufficient quantity. Vitamin D, the new “it” nutrient which has shown to be involved with just about everything from bone density to diabetes to heart disease to autism to cancer, is actually made in our body from cholesterol. Vitamin D’s scientific name is cholecalciferol - note the chole part, as in cholesterol. I’ve heard from some patients, especially those with diabetes (the adult onset type) and high blood pressure, that they have been advised to keep their cholesterol level down at around 120. I worry that these people will in for big trouble down the road if they maintain their cholesterol level that low.

In my next installment I will provide a little more detail about the different types of cholesterol and other important blood fats, discuss what those factors are that create the inflammation that causes cholesterol to become problematic and what can be done that is health promoting. So remember: cholesterol - good, inflammation - bad, and I’m sure by now you know what the ugly is.

Technorati Tags: cholesterol, inflammation, Vitamin D

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