7 Questions to Ask if Your Cholesterol is "Too High"
7 Questions to Ask if Your Cholesterol is "Too High"
When I first opened my medical practice in the mid-80s, cholesterol, and the fear of having too high a level was rarely discussed unless your cholesterol level was over 330 or so.
Over the years, however, cholesterol became a household word for something you must keep as low as possible, or suffer the consequences. Today, dietary fat and cholesterol are typically still portrayed as the worst foods you can consume.
This is unfortunate, as these myths are actually harming your health.1 Cholesterol is one of the most important molecules in your body; indispensable for the building of cells and for producing stress and sex hormones, as well as vitamin D.
Since the cholesterol hypothesis is false, this also means that the recommended therapies—low-fat, low-cholesterol diet, and cholesterol lowering medications—are doing more harm than good.
Statin treatment, for example, is largely harmful, costly, and has transformed millions of people into patients whose health is being adversely impacted by the drug. As noted by Dr. Frank Lipman in the featured article:2
“[T]he 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.”
In his article, Dr. Lipman discusses seven things you need to know when you have a talk with your doctor about your cholesterol level. For starters, it’s important to realize that the conventional view that cholesterol causes heart disease was based on seriously flawed research right from the start.
#1: Flawed Cholesterol Science Has Done Untold Harm...
This includes Dr. Ancel Keys’ 1953 Seven Countries Study,5 which linked the consumption of dietary fat to coronary heart disease. When Keys published his analysis that claimed to prove this link, he selectively included information from only seven countries, despite having data from 22 countries at his disposal.
The studies he excluded were those that did not fit with his preconceived hypothesis. Once the data from all 22 countries is analyzed, the correlation vanishes. Moreover, as noted by Dr. Lipman:
“[T]oday’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 of 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: Cholesterol Is Important for Health
Cholesterol, a soft, waxy substance, is found not only in your bloodstream but also in every cell in your body, where it helps to produce cell membranes, hormones (including the sex hormones testosterone, progesterone, and estrogen), and bile acids that help you digest fat.
It’s also important for the production of vitamin D, which is vital for optimal health. When sunlight strikes your bare skin, the cholesterol in your skin is converted into vitamin D. It also serves as insulation for your nerve cells.
Cholesterol is also important for brain health, and helps with the formation of your memories. Low levels of HDL cholesterol has been linked to memory loss and Alzheimer's disease, and may also increase your risk of depression, stroke, violent behavior, and suicide.
#3: Total Cholesterol Tells You Virtually Nothing About Your Health Risk
Your liver makes about three-quarters or more of your body's cholesterol, which can be divided into two types:
- High-density lipoprotein or HDL: This is known as the "good" cholesterol, which may actually help prevent heart disease.
- Low-density lipoprotein or LDL: This "bad" cholesterol circulates in your blood and, according to conventional thinking, may build up in your arteries, forming plaque that makes your arteries narrow and less flexible (atherosclerosis). If a clot forms in one of these narrowed arteries leading to your heart or brain, a heart attack or stroke may result.
Having defined those two types of cholesterol, it’s worth noting that there’s really only one kind of cholesterol, as previously explained by Dr. Ron Rosedale below.
The division into HDL and LDL is based on how the cholesterol combines with protein particles. LDL and HDL are lipoproteins -- 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 your arteries. If they oxidize, they can cause damage and inflammation.
Thus, it would be more accurate to say that there are “good” and “bad” lipoproteins (as opposed to good and bad cholesterol). Dr. Stephen Sinatra, a board-certified cardiologist, and Chris Kresser, L.Ac, a licensed integrative medicine clinician, have both addressed this issue in previous interviews. Some groups, such as the 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 featured 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: Dig Deeper into Your Risk Factors...
Fortunately, once you know about particle size numbers, you can take control of your health and either ask your doctor for this test, or order it yourself. Kresser recommends using the NMR LipoProfile. All major labs offer it, including LabCorp and Quest. 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: Be Very Wary of Pro-Statin Studies
Most pro-statin studies are sponsored by the drug manufacturers, which will typically skew results in their favor. Worse yet, conflicts of interest have become more of the norm than the exception when guidelines are created. For example, the revised and highly controversial cholesterol-treatment guidelines issued by the American Heart Association (AHA) and the American College of Cardiology (ACC) in 2013 were created by a number of individuals who had conflicting interests. This includes:
- The lead author, Dr. Neil J. Stone, who is a strong proponent of statin usage and has received honoraria for educational lectures from Abbott, AstraZeneca, Bristol-Myers Squibb, Kos, Merck, Merck/Schering-Plough, Novartis, Pfizer, Reliant, and Sankyo. He's also served as a consultant for Abbott, Merck, Merck/Schering-Plough, Pfizer, and Reliant.
- The second author listed, Jennifer Robinson, admitted to the New York Times in 2011 that she was taking research money from seven companies, including some top sellers of cholesterol pills.
- Another author, C. Noel Bairey Merz, received lecture honoraria from Pfizer, Merck, & Kos, and has served as a consultant for Pfizer, Bayer, and EHC (Merck). She's also received unrestricted institutional grants for Continuing Medical Education from Pfizer, Procter & Gamble, Novartis, Wyeth, AstraZeneca, and Bristol-Myers Squibb Medical Imaging, as well as a research grant from Merck. She also has stocks in Boston Scientific, IVAX, Eli Lilly, Medtronic, Johnson & Johnson, SCIPIE Insurance, ATS Medical, and Biosite.
#6: Assess Your Actual Need for a Cholesterol-Lowering Drug
As noted by Dr. Lipman, cholesterol-lowering drugs are not required or prudent for the majority of people—especially if high cholesterol and longevity run in your family. “Regardless, don’t be afraid to push back and tell your doc you’d prefer to avoid drug therapies,” he writes. “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, the following tests can give you a far better assessment of your heart disease risk than your total cholesterol alone:
- HDL/Cholesterol ratio: HDL percentage is a very potent heart disease risk factor. Just divide your HDL level by your total cholesterol. That percentage should ideally be above 24 percent.
- Triglyceride/HDL ratios: You can also do the same thing with your triglycerides and HDL ratio. That percentage should be below 2.
- Your fasting insulin level: Any meal or snack high in carbohydrates like fructose and refined grains generates a rapid rise in blood glucose and then insulin to compensate for the rise in blood sugar. The insulin released from eating too many carbs promotes fat accumulation and makes it more difficult for your body to shed excess weight. Excess fat, particularly around your belly, is one of the major contributors to heart disease.
- Your fasting blood sugar level: Studies have shown that people with a fasting blood sugar level of 100-125 mg/dl had a nearly 300 percent increase higher risk of having coronary heart disease than people with a level below 79 mg/dl.
- Your iron level: Iron can be a very potent oxidative stress, so if you have excess iron levels you can damage your blood vessels and increase your risk of heart disease. Ideally, you should monitor your ferritin levels and make sure they are not much above 80 ng/ml. The simplest way to lower them if they are elevated is to donate your blood. If that is not possible you can have a therapeutic phlebotomy and that will effectively eliminate the excess iron from your body.
An important side note: if you do decide to take a statin drug, you need to make sure you take CoQ10 or Ubiquinol with it. One in four Americans over the age of 45 currently take a statin drug, and most are not told they need to take coenzyme Q10 to buffer against some of the most devastating side effects of the drug. As previously explained by Dr. Sinatra, statins block not just cholesterol production pathways, but several other biochemical pathways as well, including CoQ10 and squalene—the latter of which Dr. Sinatra believes is essential in preventing breast cancer.
Squalene reduction caused by the statin can also raise your risk of immune system dysfunction. The depletion of CoQ10 caused by the drug is why statins can increase your risk of acute heart failure. So if you're taking a statin drug, you MUST take Coenzyme Q10 as a supplement. You cannot get enough of it through your diet. Dr. Sinatra recommends taking at least 100 milligrams (mg), but preferably 200 mg of high-quality CoQ10 or Ubiquinol daily.
#7: Focus on Boosting Your HDL
The science of heart disease is still imprecise. 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.” What exactly are these steps? 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 strategies that will help reduce your risk of heart disease, which dovetail rather precisely with my own recommendations. This includes the following:
Replace processed foods (which are loaded with refined sugar and carbs, processed fructose, and trans fat—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. Eliminate no-fat and low-fat foods, and increase consumption of healthy fats. Half of the population suffers 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, and may be a significant underlying factor of up to 96,000 premature deaths each year. For more information about omega-3s and the best sources of this fat, please review this previous article.
You also need the appropriate ratios of calcium, magnesium, sodium, and potassium, and all of these are generally abundant in a whole food diet. To get more fresh vegetables into your diet, consider juicing. Optimize your vitamin D level. Some researchers, like Dr. Stephanie Seneff, believe that optimizing your vitamin D level through regular sun exposure, as opposed to taking an oral supplement, may be key to optimizing your heart health. If you do opt for a supplement, you also increase your need for vitamin K2. Optimize your gut health. Regularly eating fermented foods, such as fermented vegetables, will help reseed your gut with beneficial bacteria that may play an important role in preventing heart disease and countless other health problems. Quit smoking and reduce your alcohol consumption. Exercise regularly. Exercise is actually one of the safest, most effective ways to prevent and treat heart disease. In 2013, researchers at Harvard and Stanford reviewed 305 randomized controlled trials, concluding there were "no statistically detectable differences" between physical activity and medications for heart disease. High-intensity interval training, which requires but a fraction of the time compared to conventional cardio, has been shown to be especially effective. 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. In one 2010 study,7 those with the worst oral hygiene increased their risk of developing heart disease by 70 percent, compared to those who brush their teeth twice a day. Avoid statins, as the side effects of these drugs are numerous, while the benefits are debatable. In my view, 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.