WHAT TO DO IF YOUR DOCTOR TELLS YOU THAT YOUR CHOLESTEROL IS TOO HIGH

I remember that when I was much younger, sometime in the mid 80’s, cholesterol and the fear of having high levels of it was a subject that was only discussed when levels reached or exceeded 350.

With time, the issue of cholesterol has become a fashionable subject and it was considered that to have it in check it means that it has to be at as low a level as possible.  Otherwise, you will get sick and you will die!

Now days, dietary fat and cholesterol are still considered as being public enemy number one and the main reason behind obesity and cardiovascular disease (CVD).

This is not only inaccurate and misleading but also unfortunate as these myths are, as a matter of fact, harming your health because cholesterol is one of the most important substances in the human body.    By its nature, cholesterol assists in the production of cell membranes, as well as takes a part in hormone production (including testosterone, progesterone and oestrogen), and bile acids that assist in digesting fat, as well as vitamin D.  Cholesterol is also indispensable to our brain which contains about a quarter of the cholesterol in our body.  In addition, it is crucial for the formation of synapse (neuron connections) which enables us to think, learn and remember.

Once we establish that cholesterols is not the enemy it is now safe to deduce that the recommended low fat and cholesterol diets, combined with cholesterol lowering medication is not necessarily the correct approach. In fact, this approach is doing more harm than good.

Treatment with statins, which are the most common cholesterol reducing medication available, is known to be largely harmful, expensive and has known side effects such as cancer, diabetes, musculoskeletal disorders, cognitive impairment and cataracts.  As noted by Dr Frank Lipman,[1] a leading expert and a bestselling author:

“The medical profession is obsessed with lowering your cholesterol because of misguided theories

about cholesterol and heart disease.

Why would we want to lower it when the research3 actually shows that three-quarters of people having a first heart attack have normal cholesterol levels, and when data over 30 years from the well-known Framingham Heart Study4 showed that in most age groups, high cholesterol wasn’t associated with more deaths?

In fact, for older people, deaths were more common with low cholesterol. The research is clear – statins are being prescribed based on an incorrect hypothesis, and they are not harmless.”

It this article, Dr Lipman discusses the seven things that in his opinion you need to know when you’re chatting about your cholesterol level with your healthcare provider.  First and foremost, you must realise that the conventional wisdom that cholesterol causes CVD is based on seriously flawed research and misrepresentation of statistical data.

1.Your Doctor May be Basing Your Diagnosis on Data That’s  Half-a-century-old

This includes the Seven Countries Study carried out by Dr. Ancel Keys 1953,[2] which linked the consumption of dietary fat to coronary heart disease. However, Keys selectively chose to analyse data from seven countries despite having at his disposal data from 22 countries in a way that proved his assertion that dietary fat is linked to coronary heart disease.  The studies he excluded were those that did not fit with his preconceived hypothesis. Once the data from all 22 countries is analysed, the correlation disappears. Moreover, as noted by Dr. Lipman:

“…Today’s mainstream thinking on cholesterol is largely based on an influential but flawed 1960s study which concluded that men who ate a lot of meat and dairy had high levels of cholesterol and heart disease.

This interpretation took root, giving rise to what became the prevailing wisdom of the last 40+ years: lay off saturated fats and your cholesterol levels and heart disease risk will drop.

This helped set off the stampede to create low-fat/no-fat Frankenfoods in the lab and launch the multibillion-dollar cholesterol-lowering drug business in hopes of reducing heart disease risk. Did it work? No.

Instead of making people healthier, we’ve wound up with an obesity and diabetes epidemic that will wind up driving up rates of heart disease – hardly the result we were hoping for.”

2. Pssst. Guess what? You Actually Need Cholesterol

Cholesterol, a soft, waxy substance, is found not only in your bloodstream but also in every cell in your body, where it assists in the production of cell membranes, as well as takes a part in hormone production (including testosterone, progesterone and oestrogen), and bile acids that assist in digesting fat, as well as vitamin D.

Cholesterol is also indispensable to our brain which contains about a quarter of the cholesterol in our body.  In addition, it is crucial for the formation of synapse (neuron connections) which enables us to think, learn and remember.  Low levels of HDL (‘good’) cholesterol has been linked to memory loss and Alzheimer's disease, and may also increase your risk of depression, stroke, violent behaviour and suicide.

3. Your “Numbers” Measure Cholesterol, But Really How Bad Is It?

The liver makes about 75% or more of the body's cholesterol, which can be divided into two types:

• High-density lipoprotein or HDL:  AKA "good" cholesterol, which may actually help prevent heart disease.

   

• Low-density lipoprotein or LDL:  AKA "bad" cholesterol circulates in your blood and, according to conventional wisdom, may cause atherosclerosis that can lead to heart attack or stroke.

However, the division into HDL and LDL is based on how the cholesterol combines with protein particles. LDL and HDL are lipoproteins, which are fats combined with proteins. Cholesterol is fat-soluble, and blood is mostly water. For it to be transported in your blood, cholesterol needs to be carried by a lipoprotein, which are classified by density.

Large LDL particles are not harmful. Only small dense LDL particles can potentially be a problem, as they can squeeze through the lining of the arteries. If they oxidise, they can cause damage and inflammation.  Thus, it would be more accurate to say that there are “good” and “bad” lipoproteins rather than good and bad cholesterol. 
For more on this issue: https://www.youtube.com/watch?v=awA2fsa94MI&feature=youtu.be

Some groups, such as the American National Lipid Association (NLA), are now starting to shift the focus toward LDL particle number instead of total and LDL cholesterol, in order to better assess your heart disease risk. But it still has not hit mainstream. As noted in the Dr Lipman’s article:

“Consequently, you may have blood teeming with the less alarming large particle LDL, and still get signed up for a statin. And with the new controversial – and in my book dangerous – ‘wider net’ guidelines proposed by American College of Cardiology and the American Heart Association, expect that to happen a lot more. The new guidelines6 will make an estimated additional 15 million more adults (plus a few kids as well) ‘eligible’ to take statins in an effort to drug down their numbers, regardless of what type of LDL they have.”

4. Insist That Your Doctor Digs Deeper

Once you are aware of particle size numbers, you can take control of your health by either asking your doctor for NMR LipoProfile test or Cardio IQ Ion Mobility test, or order on of them yourself. This test is widely available through many labs or by corroboration with labs that offer it.  In Europe and other parts of the world where NMR and Cardio IQ Ion Mobility tests are not available, LDL particle number is more commonly measured using an indirect marker, apolipoprotein B (apoB). ApoB is a protein required for the formation of the LDL particle. About 90-95% of apoB particles are LDL particles, which makes apoB a fairly accurate measure of LDL particle number. If you live in a country where the NMR profile is not available, you can use the apoB test to roughly determine your LDL particle number, and then use triglycerides, HDL, fasting blood sugar, blood pressure and waist-to-hip ratio to determine if you have insulin resistance. As noted by Dr. Lipman, if your doctor tells you your cholesterol is too high based on the standard lipid profile, getting a more complete picture is important—especially if you have a family history of heart disease or other risk factors. He writes:

“Press your doctor to review and assess the other often overlooked but possibly more important factors that can shed a brighter light on your unique situation – namely tests which look at hs-C-reactive protein, particle sizes of the LDL cholesterol (sometimes called NMR LipoProfile), Lipoprotein (a) and serum fibrinogen. These measurable physical clues will help fill in a few more pieces of the puzzle, and enable you and your doctor to develop a more customized program to help manage your risk, with or without cholesterol drugs. If your doc’s not interested in looking under the medical hood, then it may be time to switch to a new mechanic.”

5. For Many Statin Studies, the Fix is Usually in Well Before the Results Are
 

Most pro-statin studies are sponsored by pharmaceuticals, which will typically skew results in their favour. Worse yet, conflicts of interest have become the norm when guidelines are created. As Dr Lipman notes:

“…It’s also not uncommon for the doctors involved with setting the statin guidelines to have a stake in the companies that produce them, so small wonder the drugs are pushed on the public with such enthusiasm.”

6. If Mom and Dad Made It into Their 90s, Think Twice
 

According to Dr. Lipman, cholesterol-lowering drugs are not required or prudent for the majority of people - especially if high cholesterol and longevity are prevalent in your family.  He writes:

“…Regardless, don’t be afraid to push back and tell your doc you’d prefer to avoid drug therapies. Assuming you’re not in a mission critical situation, discuss the possibility of trying a more holistic approach to get your numbers down to what is considered a normal or healthy zone based on all of your specific risk factors, not just your cholesterol numbers.”

 

In addition to the tests mentioned earlier, including the NMR LipoProfile and Cardio IQ Ion Mobility test, the following tests can give you a far better assessment of your heart disease risk than your total cholesterol alone:

• Triglyceride/HDL ratios: should ideally be less than 2

   

• HDL/total cholesterol ratio: HDL percentage is a very effective heart disease risk factor. It is calculated by dividing HDL level by total cholesterol. This percentage should ideally be greater than 24%. Below 10%, it's a significant indicator of risk for CVD

   

• Fasting blood sugar level: Studies have shown that people with a fasting blood sugar level of 100-125mg/dl  (5.55-6.95mmol/L) had nearly a threefold increase in the risk of having coronary heart disease than people with a level below 79mg/dl (4.39mmol/L)

   

• Fasting insulin level: Food high in carbohydrates like fructose and refined grains produces a swift rise in blood glucose followed by elevated insulin to compensate for the rise in blood sugar. Insulin which is released from carb rich food consumption, promotes fat and makes it more difficult for the body to lose extra weight and fat (particularly around midriff section). It is one of the major contributors to CVD.

   

Iron level: Iron can potentially be a very powerful oxidative stress, therefore excess iron levels can damage blood vessels and increase risk of CVD. Ferritin levels should be regularly monitored and ideally should be not much above 80ng/ml. High levels may be lowered by donating blood or alternatively by undergoing therapeutic phlebotomy.

However, if you do decide to follow your doctor’s recommendation and take a statins, you need to make sure you take coenzyme CoQ10 or Ubiquinol (the reduced form) with it. The majority of patients are not told they need to take coenzyme Q10 to shield against some of the most harmful side effects of the drug.  As discussed above, statins block not only cholesterol production pathways, but several other biochemical pathways, including CoQ10 and squalene—the latter is considered essential in preventing breast cancer.

Squalene reduction caused by the statin can also raise the risk of immune system dysfunction. The depletion of CoQ10 caused by the drug is why statins can increase your risk of acute heart failure. You should discuss the recommended dosage of CoQ10 with your healthcare provider.

7. Stack the Deck and Play Your Cards Right

The accuracy of the science of heart disease is evolving. As noted by Dr. Lipman:

“Ultimately, the more HDL-boosting steps you take, the better the odds, and if you’re able to do it without medicating the numbers, so much the better.”

Needless to say, your diet has a lot to do with it, and step number one is to ignore conventional advice to eat a low-fat, low-cholesterol diet.

Dr. Lipman includes a list of “10 essential steps to help stabilise and improve your situation and reduce risk overall”

I concur with his recommendations which include:

• Ignore conventional advice to eat a low-fat, low-cholesterol diet. Replace processed foods (which are loaded with refined sugar and carbs, processed fructose, and transfats - all of which promote heart disease) with whole, unprocessed or minimally processed foods, ideally organic and/or locally grown.

• Avoid meats and other animal products such as dairy and eggs sourced from animals raised in confined animal feeding operations (CAFOs). Instead, opt for grass-fed, pastured varieties, raised according to organic standards devoid of fertilizers and antibiotics.

• Stop eating no-fat and low-fat foods, and increase consumption of healthy fats. 50% of people suffer with insulin resistance and would benefit from consuming 50-85 percent of their daily calories from healthy saturated fats, such as avocados, butter made from raw grass-fed organic milk, raw dairy, organic pastured egg yolks, coconuts and coconut oil, unheated organic nut oils, raw nuts, and grass-fed meats. No- or low-fat foods are usually processed foods that are high in sugar, which raises your small, dense LDL particles. 

  
  Balancing your omega-3 to omega-6 ratio is also key for heart health, as these fatty acids help build the cells in your arteries that make the prostacyclin that keeps your blood flowing smoothly. Omega-3 deficiency can cause or contribute to very serious health problems, both mental and physical.

• Ensure you have the correct levels of calcium, magnesium, sodium, and potassium, and all of these are generally abundant in a whole food diet. You might want to consider juicing to get more fresh vegetables into your diet.

• Ensure your vitamin D levels are adequate.  Ideally through safe exposure to the sun or by taking supplements, as this will allow your body to create vitamin D sulphate - another factor that may play a leading role in the prevention of arterial plaque formation.

• Consume fermented foods daily. This will optimise the intestinal microflora in your inner garden as well as introduce beneficial bacteria into your mouth. This will boost your overall immunity. Poor oral health is another indicator of increased risk of heart disease

• Avoid smoking, taking drugs or consuming high quantities of alcohol or caffeine.

• Exercise regularly. Ensure to incorporate HII (high intensity interval) exercise in your routine.  This will also optimise the production of HGH (human growth hormone).

• Pay attention to your oral health. There's convincing evidence linking the state of your teeth and gums to a variety of health issues, including heart disease.

• Avoid statins, as the side effects of these drugs are numerous, while the benefits are debatable. According to many Functional and Integrative Medicine doctors, the only group of people who may benefit from a cholesterol-lowering medication are those with genetic familial hypercholesterolemia. This is a condition characterized by abnormally high cholesterol, which tends to be resistant to lowering with lifestyle strategies like diet and exercise.

[1] Care2.com December 29, 2014

[2] Nutrition. 1997 Mar;13(3):250-2