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Cholesterol

Over nine million Americans are currently taking a prescription medication to lower their cholesterol. These include drugs in the “statin” family, which includes names such as Lipitor, Zocor, Pravachol, Mevacor, Lescol, and until recently Baycol. At an average cost of about $2.50 per day (for an average dose), that adds up to $22.5 million that Americans spend on these drugs every day, or $675 million per month. But cost of the medications themselves is not the only issue. The cost of treating the side effects of these medications is even higher.

The statin medications are known to cause liver problems that require everyone taking these medications to have regular monitoring of liver functions. Complications of treatment also include potentially lethal muscle damage, known as rhabdomyolysis. This specific complication was the cause of over 50 deaths related to the use of Baycol, which led to its withdrawal from the market by Bayer Pharmaceuticals in August of 2001.

Statins have also been associated with an array of side effects including abdominal pain, diarrhea, indigestion, nausea, constipation, skin rashes, headache, hair loss, cataracts, dizziness, memory loss, insomnia and depression. So why are so many people taking these drugs? For two reasons, really:

• Cardiovascular disease remains the leading cause of death in the U.S., accounting for about 40% of all deaths in the U.S., and statin drugs have been shown to reduce the risk of heart attack and stroke, but
• Americans have not been given adequate or proper recommendations on how to control their cholesterol levels without medications.

One important point is that cholesterol is not all bad. In fact, cholesterol is a necessary constituent of every cell in our bodies. We need cholesterol – if we didn’t have any we would cease to be alive. Cholesterol is the starting point and critical first ingredient in the production of many of the hormones in our bodies including testosterone, estrogen, progesterone, cortisol, DHEA, pregnenolone and others. Research has shown that high levels of cholesterol can actually at times predict good health.

A study of cholesterol levels in over 4000 older men and women (aged 75 and above) showed that, “Persons with the lowest total cholesterol levels (less than 160 mg/dL) had the highest rate of death from coronary heart disease, whereas those with elevated total cholesterol levels (greater than 240 mg/dL) seemed to have a lower risk for death from coronary heart disease.” Annals of Internal Medicine, May 15, 1997. This study showed that at least in older people, low cholesterol levels may not be a healthy finding, and high cholesterol levels may not necessarily be bad. This study, of course, did not apply to younger or middle-aged Americans. Part of the reason for this paradoxical result was that researchers in this study were only looking at total cholesterol levels, not the levels of “good” or “bad” cholesterol.

The point here is that when we talk about lowering cholesterol, we mean lowering the "bad" cholesterol, not the "good".

In fact, we would generally like to raise the “good” cholesterol level, known as the HDL, or high-density lipoprotein. In my practice some of the healthiest 80 and 90-year olds I know have very high cholesterol levels, but also have very high HDL levels. In one of the country’s largest studies of cardiovascular disease, known as the Framingham Heart Study, high levels of HDL were protective and reduced the chance of heart attacks. So any strategy to lower cholesterol should be combined with a strategy to raise the HDL.

How can we improve our cholesterol levels without pills?

A common fallacy is that to improve cholesterol we should eat a low fat diet. Research has disproved this myth, largely because all fats are not created equal. High quality fats help to lower cholesterol and should be included in the diet in ample amounts, up to 30% of one’s daily caloric intake. For an average middle-aged man this constitutes between 60 and 80 grams of fat daily, for women 40-60 grams. These beneficial, high-quality fats come from sources such as fish, flax seeds, olive oil, avocados, and nuts. Here is a chart summarizing an approach to choosing fats wisely:

* Use plain (non-roasted) nuts and all-natural nut butters
** Extra virgin, first cold pressing is best
*** Fake fat used in some processed products

Another reason that low-fat diets are not always healthy is that often, when people eat a low-fat diet, they are consuming an excess of sugar, refined grains and starchy carbohydrates. This pattern of eating has an adverse effect on cholesterol levels by raising the bad cholesterol, lowering the good and raising triglycerides, another one of the “bad” fats in the bloodstream. When eating to lower cholesterol, it’s important to limit the amount of sugar, refined grains and cereals, and starchy carbohydrates in our diets. As a general rule of thumb, the more processed, refined, or starchy a carbohydrate, the worse it is for your cholesterol levels. The more fiber a carbohydrate contains, the better. Here are some suggestions to help you choose carbohydrates wisely:

• Increase your intake of high-fiber carbohydrates, as found in vegetables and fruits, beans, nuts & seeds, whole grains such as high-fiber whole wheat and wheat germ, brown rice, quinoa, millet, and whole oats.
• Whenever possible, choose whole grain or colored varieties of carbohydrates rather than refined or “white” carbs, e.g. a sweet potato is better than a white potato; brown rice is better than white rice; sprouted 7-grain whole wheat bread is better than white, French, Italian or sourdough bread; whole wheat pasta is preferable to white pasta.
• Limit your intake of starchy vegetables such as potatoes, parsnips turnips, and beets.
• Look for whole grain cereals with no sugar added, such as Uncle Sam’s or Flax ‘n Fiber
• It’s important to try and avoid those tempting sweet baked goods such as cookies, cakes, pastries, croissants, donuts, muffins, and the like.

Here is a comprehensive program to improve cholesterol levels:

• Get more FIBER. This means your major foods ought to be coming from the fruits and vegetables. Beans, nuts (especially walnuts), seeds, avocados, flax and whole grains are helpful. Avoid processed cereals. Aim for at least 30 grams of fiber daily. Add 1 tablespoon of organic ground flax seeds (available in your natural foods store) to salads or veggies daily.
• Limit or eliminate SUGAR, refined grains and starches.
• Get an oil change – substitute olive oil, fish and fish oil, flax oil, nuts & natural nut butters instead of animal fats, dairy fats and vegetable oils. High quality oils should constitute up to 30% of your daily calories. Eliminate hydrogenated oils, shortening, fried foods, and tropical oils. Increase fish in your diet and reduce red meat. Adding soy foods such as tofu, tempeh, edamame and miso have a beneficial effect on cholesterol levels.
• Don’t be afraid of eggs. An egg or two a day will not raise your blood cholesterol level, and eggs are a good source of protein. Look for high quality omega-3 eggs in your health food store.
• Lose weight – if you’re overweight then losing even a modest amount of extra weight will have a dramatic effect on your cholesterol levels
• Exercise – the benefits of exercise include raising the good (HDL) cholesterol and lowering the total cholesterol, not to mention the improvement in cardiovascular fitness, blood pressure, blood clotting and the mood-enhancing effect. Daily aerobic exercise is best for this, and even walking helps tremendously.
• A good multivitamin that includes folic acid, vitamins B6, B12 and B3 (niacin), as well as trace minerals, is helpful.

As with any health program, it’s important to confer with your physician and monitor your progress. We’d recommend getting a baseline cholesterol profile (including total cholesterol, HDL, LDL, and triglycerides) before beginning the program. You should see results in your blood work within 6 weeks.