Natural Medicine Clinic Publications

Cholesterol--Too Much of a Good Thing

By Nancy Aagenes, ND

***Editorial Note: This is an old article that explains some basics about cholesterol. Subsequent to this writing, I have learned to use other important lab work to assess heart risk. Read this only for thinking about cholesterol and understand that other things are necessary to determine your coronary risk.

Cholesterol is a solid waxy substance. Elevated blood cholesterol levels are linked to heart attacks and strokes. It is not a fat, but it travels in the same company. It is essential normal metabolism. Our liver makes 60 to 70 percent of our cholesterol-our bodies insurance if we can't eat enough in times of famine. The remainder comes from diet. Our brains are cholesterol rich. Cholesterol is basic raw material for hormones. It's what helps our skin hold fluid in. Bones would be hollow and brittle without it.

The problem is with abundance-too much of a good thing. When we have too much of the low density kind (LDL) it deposits in our arteries and veins. It clogs things up. And becomes prone to inflammation breaking it loose, causing clotting and chunks traveling in the blood-the recipe for heart attack and stroke.

The high density lipoprotein (HDL cholesterol) is called "good" because it combines with fiber and is excreted. It leaves the system rather than becoming sludge in it.

Medically we look at two things: What is the total? How much of that is leaving the body? That is, how much is HDL? Divide the HDL number into the total. That number indicates your coronary risk. Your total is 250 and your HDL is 35. Your risk ratio is 7.1 and that's not so good. We need to change something. Your total is 250 and your HDL is 85, your risk number is 2.9. That's not so bad, tho it would be wise to lower the 165 mg available for deposit in the vasculature. Ideally, I like my patients at coronary risk ratio 4 or less, with an LDL of less that 130 mg/dl. If you have active coronary disease, researchers are now recommending that your LDL be kept under 100 mg/dl.

Cholesterol acts like sediment in a stream. If you keep the vessels otherwise healthy the sediment stays in solution a little better, does less harm. It is with damaged artery linings that cholesterol causes the most problems. Linings are damaged by things like inadequate Vitamin C, Vitamin E, Vitamin B6, excess pollutants like tobacco smoke, alcohol, sugar, hydrogenated heat damaged fates, overcooked proteins, combustion engine exhaust.

Your total cholesterol is 253, with an HDL of 47. Your risk ratio is 5.4. How can you make sure you are getting better? The first strategy is four fold:

1. Work with decreasing dietary intake of the bad fats.
2. Maximize the HDL, Try to get that good cholesterol number to increase.
3. Protect the heart in other ways.
4. Get your thyroid function checked too. Low thyroid function increases cholesterol.

First, decrease or completely eliminate vegetable oils, shortenings, margarine. Read labels and don't buy anything that says "hydrogenated" or "partially hydrogenated". Use olive oil as your primary cooking oil. The fat in fish will also help reduce cholesterol. Not the bottom feeders like lobster or shrimp, but the fish that swim in cold water like salmon or trout!

If you don't like to eat fish supplement capsules of EPA and DHA--the kinds of oils that help.

Minimize animal protein and fat and do NOT overcook them. There are new studies suggesting that overcooking is more a problem than the substance itself. Luckily we like steaks rare at our house!

Increase fiber. HDL cannot be excreted unless the diet is high in fiber. Use 1/4 cup of oat bran every day, for example. Put it in muffins, or pancakes, or cook it with oatmeal. On the days you miss getting oat bran in your diet use a fiber supplement that is psyllium based. Keep looking for a form that feels easy for you to use.

Your liver will use sugar and the bad fats (even if they are cholesterol free) to manufacture cholesterol. Decrease your sugar intake too.

Second, understand that garlic, onions and exercise will raise the HDL number and decrease total. If you don't like garlic, you can use deodorized garlic pills. With carefully matched diets those eating 50 grams of garlic and 600 grams of onion weekly had a total average cholesterol of 159 mg/dl. Those having no garlic or onions were at 208 mg/dl. If you really hate garlic, try the other strategies first. Pick the ones that suit you best and see if that is enough to move the ratio in a health direction.

Third, many other things protect the heart: aerobic exercise, stress reduction, weight management and intelligent supplementation are on the list.

It might motivate you to try natural medicine when you realize that several of the cholesterol-lowering drugs are actually associated with an increase in noncardiovascular mortality. You don't have a heart attack, but are more likely to die of something else. For some people the drugs are still necessary. Then supplements can be used to protect against the liver toxicity and cancer causing nature of the drugs.

What supplements might be useful? Niacin is low cost and is proven effective. That's plain old Vitamin B3. Its down side is that in very large doses it also can be toxic to the liver and even in small and safe doses it can cause an irritating flushing, heat, prickly sensation for a few minutes after it is absorbed. Start with small doses. Take it with food.

At the Natural Medicine Clinic we use inositol hexaniacinate, a form of niacin that causes less flushing and less liver complication. It is marketed as NiaSafe by Thorne, a very good natural products company.

The effect of niacin on cholesterol is doubly beneficial. It increases the good HDL and decreases the bad LDL. Also its effects, while slower than the drugs, are longer lasting and if you stop taking it some benefit will continue. Some drugs used in the past were associated with an increased mortality rate when the drug was discontinued. Niacin is safer.

Niacin comes in many forms and you may want the advice of a knowledgeable care provider to choose a kind and dose best for you.

Vitamin E is an all time favorite for protection of the vasculature. One study read years ago claimed that even without lowering cholesterol a group taking Vitamin E had fewer heart attacks and strokes. If your cholesterol is high every day for the rest of your life take 400 IU of d-tocopherols (Vitamin E).

Gugulipid (Commiphora mukul), a tree native to India also has been confirmed in clinical studies to lower cholesterol. Add that to your list if after four months the cholesterol isn't lowered using more commonly available supplements.