By Michael E. Reece, ND
Cholesterol management has certainly garnered much attention, with elevated levels associated with one of the most common causes of death in the United States: heart disease. While other factors, such as smoking, elevated blood pressure and diabetes, increase risk of having a heart attack, evidence has shown that elevated cholesterol (along with certain lipoproteins) increase risk of death from heart disease.
It is important to understand that cholesterol is not a bad thing. Cholesterol is an important component of cell membranes, where it helps with permeability. It is also a precursor for several hormones, including estrogen, progesterone, testosterone, cortisol (your body's natural cortisone), and vitamin D.
Cholesterol is transported in the blood attached to lipoproteins. It can be confusing hearing about high density lipoprotein (HDL) and low density lipoprotein (LDL) referred to as "good" and "bad" cholesterol respectively. But these lipoproteins act as taxicabs, transporting cholesterol throughout the body. HDL transports cholesterol to the liver, while LDL transports cholesterol from the liver to body cells. Elevations in the amount of LDL and VLDL (very low density lipoproteins) are associated with increased risk for developing heart disease. Additional blood studies should include a high sensitivity C-reactive protein (which can indicate inflammation in the blood vessels) and lipoprotein (a).
Statin drugs are the treatment of choice in conventional medicine for cholesterol control, as they have demonstrated decreased coronary deaths in several scientific studies. They work by inhibiting an enzyme involved with cholesterol synthesis. Statin drugs are not without problems, however, with side effects including headaches, muscle aches, abdominal cramping, bloating, nausea and liver toxicity. They also deplete Coenzyme Q10, a nutrient important in cellular production of energy. Other drugs used for controlling cholesterol include ezetimibe (which reduces cholesterol absorption in the small intestine) and fibrates (which inhibits cholesterol and triglyceride synthesis).
Dietary modification is essential for controlling elevated cholesterol levels. Most of what accounts for the total cholesterol level seen in blood tests does not come from consumption of cholesterol itself, but rather from eating foods that your body uses to make cholesterol. Saturated fat and "trans" fatty acids (such as what is found in margarine and hydrogenated vegetable oils) both contribute to increased cholesterol production and should be avoided. Reduction in the overall intake of fats from red meat, dairy products and processed foods remain important in controlling cholesterol and triglyceride levels. Refined sugar intake is also associated with elevated cholesterol and triglycerides. This includes the high-fructose corn syrup commonly used in sodas and processed foods.
Consumption of foods that help lower cholesterol also help with treating other common health problems such as diabetes, insulin resistance, obesity and hypertension. Fiber-rich foods from vegetables, fruits, nuts, seeds and legumes may be helpful. Fiber is the indigestible portion of the plant cell wall, and exists in soluble and insoluble forms. It is the fiber which slows down absorption of fats and sugars in the intestines.
Niacin has been shown to raise HDL and decrease LDL and triglycerides. Niacin does have well-known side effects of skin flushing, along with occasional nausea and gastric irritability (all of which may be lessened by taking with food and/or lots of water). Sustained-release niacin reduces skin-flushing and is generally better tolerated, but may cause liver toxicity. Blood lipid levels, liver function tests, and uric acid level should be checked every 2-3 months. The "no-flush" niacin (inositol hexaniacinate), while touted as a niacin alternative (and does not have the problems associated with immediate or extended release niacin), has shown little benefit in normalizing lipid levels when compared to niacin.
Other cholesterol reducing agents include cold-water fish, omega-3 oils (EPA and DHA), pantethine (biologically active form of pantothenic acid), gugulipids, and vitamin C. Garlic and onions help lower LDL levels and raise HDL levels. Red yeast rice (RYR) contain statin-like compounds called monacolins. Studies have shown effects similar to statin drugs, where total cholesterol and LDL cholesterol levels are lowered, and HDL cholesterol levels are increased. C-reactive protein levels were also reduced with red yeast rice. RYR should not be used with statin drugs, and may also deplete levels of coenzyme Q10.
While the list above is not exhaustive, no program to reduce cholesterol (or other health problems) would be complete without mentioning regular exercise. Numerous studies have shown the importance of aerobic exercise in controlling cholesterol levels and maintaining good cardiovascular health.