I have had a request to revisit cholesterol and options for treatment.  To understand what your cholesterol goal should be you need to know more than just your regular, standard cholesterol numbers.

As far as treatments go, the lipidologists (those physicians that focus on cholesterol) will show you study after study of all the heart disease they are saving with more and more aggressive treatment. However, there are also increasing reports of links to dementia, liver failure, blood sugar issues as well.  Hmmm….what do we do?

READ ON to learn 5 tips that may help with cholesterol….

Here are 5 tips I have found to help with cholesterol:

  1. Diet: I cannot stress this enough.  If you are eating tons of animal protein (meat, dairy etc) then your cholesterol will be higher.  Even if you have the Lp(a) or a familial type if you eat junk your numbers will only be worse.  The DASH diet has had lots of success with teaching people how to eat to lower their cholesterol so look it up!
  2. Exercise: we know that if you move and exercise that cholesterol improves so as the saying goes….just do it!
  3. Decrease stress: during times of high stress I often see spikes in cholesterol so it stands to reason that continued high stress can cause higher cholesterol
  4. Supplements:
    •      Bergamot: this is a natural product made from the peel of an orange.  I have seen some really good results with this product.  It can be a stand alone supplement or paired with other supplements or even statin medications for a synergistic effect.  It doesn’t seem to work in everyone but it’s worth a try because there are very few side-effects. My favorite is Bergamot by Orthomolecular.
    •      Red yeast rice (RYR): I loved RYR because it worked.  RYR is a natural statin and is what the drug Lipitor is based off of.  While the risk of muscle weakness and side-effects are present with RYR this product seems to be better tolerated that typical statins and works just as well.  HOWEVER, the powers that be just mandated that all RYR products take out their active ingredient because it was acting like a statin and there was a potential for side-effects.  The products on the shelves today have to meet the new standards so if you were taking a RYR product and now it is not working this would be why.  I still think RYR products are worth trying though because they might still be able to reduce the cholesterol but probably not as much as before.  Be sure and stop it if you have any muscle aches or side-effects though.  I reach for Lipotrienols by Designs for Health.
    •      Fish oil: I love fish oil for high triglycerides and it can help if the cholesterol is super sticky but it doesn’t really lower the LDL’s much.  There is a lot more to fish oil than just grabbing the first bottle you see on sale.  Different EPA/DHA ratios help in different ways.  I reach for Orthomega by Orthomolecular for cholesterol issues.
    •      Niacin: niacin has shown lots of promise but its’ use is limited by the side-effects.  The niacin flush is a real deal and can be very bothersome.  The higher the dose the more you flush.  The non-flushing kinds don’t work as well and in high doses may actually create other issues.  Niacin is good for raising HDL and does help in some people to lower the Lp(a).
    •      Tocotrienols: This is a special form of vitamin e that can help change the sizes of the LDL to larger particles that aren’t as sticky.
    •      Other ingredients that have shown promise especially when combined together. Ingredients like guggul, artichoke leaf extract and flavones are examples.

5.  Know your numbers and what they mean.  We have all heard of the goal of total cholesterol is less than 200.   Not so fast because this number is just a general number.  It really doesn’t tell us much and because it includes the HDL this number is often artificially raised.  So, set total cholesterol aside for now and let’s dive in to what you really need to know.

  •      Triglycerides: we want a non-fasting triglyceride number to be less than 160 and a fasting number to be around 75
  •      HDL: for men we want this number above 40 and women above 50.  Emerging literature is indicating that a really high HDL (greater than 100)  might actually be contributing to plaque formation.  There is a possibility that these people have dysfunctional HDL’s that decrease their protective effect.  Research is ongoing in this area so stay tuned.  For now, hang on to the higher the HDL the lower the risk of heart disease.  If you do have very high HDL’s then make sure all of your other numbers are really good.
  •      LDL: LDLs take the brunt of the big bad uglies.  Traditional goals set the limit less than 130 but more studies are reporting levels less than 100 to be ideal.  There is more to the LDL than just the number though and this needs to be considered as your goal may need to be lower.
    • LDL size/pattern. Cholesterol particles come in different sizes.  You can have large LDL particles which are ideal because they can’t get lodged and cause plaque as easily compared to the small, sneaky LDL particles.  The smaller particles just love wedging themselves in our membranes inviting plaque.  The large pattern is called pattern A or type A and the small one is pattern B.  You want an A!  If you have a very high LDL (above 175)  then you most likely have some form of familial hypercholesterolemia and are very resistant to typical changes of diet, exercise, supplements and often many of the cholesterol medications
    • These are some of the breakdown particles of the LDL and are the very bad guys.  You can measure this number and if these are elevated then you need to make some changes!
    • Lipoprotein (a) or LP(a). I think this marker is one of the most important markers in deciding what your goal of LDL should be.  Lipoprotein (a) is a particle that carries cholesterol, fats and proteins in your blood.  It is inherited from one or both of your parents and stays relatively stable throughout your life except can go up in post-menopause women or increase with certain medications.  Diet and exercise don’t really affect this number.  Elevated lipoprotein (a) increases the risks of plaque formation regardless of what your cholesterol numbers are!  Even if your cholesterol numbers are low and in really good ranges you could still be forming plaque.  If you have an elevated Lp(a) then your target goal of LDL should be closer to 70 or lower.  If you have a high Lp(a) & family history of heart disease at a young age then I recommend getting a calcium heart score as well as looking at the carotid arteries to see if you already have plaque. This information will help you decide how aggressive to be going forward with lowering your numbers.
  • Other important markers that make a difference include if you have inflammation or blood sugar issues. I measure the hsCRP (high sensitivity c reactive protein) and want this number to be less than 1.  The A1C is a good marker for blood sugars and you want this number less than 5.6.  If these markers are elevated then your risk of heart disease increases so combine this with a cholesterol issue and the risks increases exponentially.Know what your numbers are and what they mean…..
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There are a lot of different choices of medications available with different mechanisms of action if you do need cholesterol lowering medication.  Just because you react to one statin does not mean you will react to another one.  Some statin medications have been shown to raise Lp(a) so if your level is already high then your physician needs to be aware so they can steer clear of those.  In addition, with all the research going on there are new pathways to address lowering cholesterol.  The PCSK9 inhibitors are an example.  These drugs are in the family of biologic drugs as they are monoclonal antibodies that inhibit PSCK9.  PSCK9 blocks receptors on the surface of the liver that allows LDL to be brought into the liver for metabolism.  When the PSCK9 is inhibited more receptors are available and therefore more LDL is brought into the liver for metabolism resulting in lower LDL levels in the blood stream.  Because these drugs are not statins the side-effects are different and for people who cannot tolerate the statins they may be a good option.  This is an injection and insurance has been slow to jump on board so be prepared to fight for this drug!

If you are placed on a statin medication, start taking CoQ10 (coenzyme Q) 200mg for at least 2 weeks prior to starting it to try to avoid side effects.  As long as you are taking the statin then continue the CoQ10 because the statin medications deplete CoQ10.  CoQ10 is an antioxidant and is used for cellular energy.  You won’t feel any different taking it but your body will know so just take this consistently.

There is so much to cholesterol and medications that I haven’t covered so just be aware that these medications can come with a whole host of side-effects.  If you are forming plaque then you need to weigh the risks and benefits of taking medications and discuss all your options with your physician.

To your health,