Heart disease is the number one killer of Americans. Find out how to properly assess your risk and what tests you should be having done.
Heart disease is the number one killer of Americans. Find out how to properly assess your risk and what tests you should be having done.
In my clinic people come to see me for all kinds of reasons. One of the reasons people often see me is because they have high cholesterol. High cholesterol has been linked to heart disease and is seen as one of the main causes of preventable death in this country.
This theory that high cholesterol actually causes heart disease by itself has many holes in it. However, the pharmaceutical companies would like you to believe that if you lower your cholesterol you will significantly reduce your risk of having a heart attack or a stroke. The evidence does not support this statement.
Cholesterol is not an independent risk factor for heart disease. So what does that mean? It means that high cholesterol alone is not enough to cause heart disease. There are many other factors that must be present in order for heart disease to occur. The main risk factor is inflammation. This inflammation can be measured in a simple blood test. The tests you should request from your doctor are called hs-CRP and homocysteine. Both of these are inflammatory markers and they give a good indication of your risk factor for a future cardiovascular event or heart attack/stroke.
The theory that high cholesterol alone causes heart disease is flawed. For example, there are large populations of people that have very high cholesterol and heart disease is almost nonexistent in their culture. The Eskimo tribes of the Arctic are great examples of this. Also, research shows that 50% of people that have heart attacks have cholesterol that is considered too high (>200 mg/dl). That means that the other 50% have cholesterol numbers that are within the normal ranges!
With that said, cholesterol does increase your risk for heart disease in the presence of other risk factors like inflammation. It does not make sense to lower cholesterol alone and expect to be protected from heart disease. It does make sense, however, to work on those levels in conjunction with reducing your other risk factors. Today I will tell you of the best natural ways that you can lower your cholesterol.
For a quick reference here are the current medical guidelines for cholesterol.
In my opinion everything should start with diet. Study after study has confirmed that eating a low carbohydrate diet is much more effective in the short term and long term in managing cholesterol levels. It sounds counter intuitive that eating a diet that is higher in fat reduces cholesterol levels but the data is there. The mantra that eating fat raises cholesterol levels does not hold true. It is actually the sugar (carbohydrate) that causes cholesterol levels and triglyceride levels to sky rocket. I routinely put my patients on low carbohydrate diets to reduce cholesterol and have yet to see it fail. The only problem is that sometimes their cholesterol levels become too low! Low cholesterol is just as problematic as high cholesterol.
This one might be a no-brainer, but it must be incorporated. Exercise has many benefits, but specifically it is known to raise the HDLs and lower the LDLs. It also improves heart muscle function, mood, cognitive performance, bone strength and many other factors associated with overall wellness. I can’t stress exercise enough.
Also known as phytosterols, these naturally occurring substances are found in high amounts in vegetable oils. They are mostly undigested and act by inhibiting your absorption of cholesterol in the following way – they prevent cholesterol from being emulsified in the gastrointestinal track. When fats, like cholesterol, are not emulsified the body cannot absorb them. Because plant sterols are not absorbed, they have very little, if any, side effect. They work wonders for people with high cholesterol. My advice would be not to purchase these over the counter. In speaking with some nutrition companies I have found that these are rather difficult to put into supplement form so buying them over the counter from a discount brand is unlikely to produce the results you are looking for. Purchase them from a doctor trained in functional medicine and who works with a reputable nutrition company. They may be slightly more expensive, but you get what you pay for. Here is a link to my website and the companies that I use.
Niacin, or vitamin B3, is another great natural way to lower cholesterol numbers. It is found in red meat, chicken, turkey and beans among other things. It is extremely safe with the only side effect being a temporary flushing effect in the skin shortly after taking it. This can be avoided by purchasing a non-flush niacin. It has been shown to reduce LDL (bad) cholesterol and increase the HDL (good) cholesterol. Doses are different for everyone and can range from 500 to 5,000 mg per day taken one to two times per day. It has been shown to reduce heart attacks by 27% and stroke by 26%.
Fish oil is great for a lot of things. While it does not directly impact total cholesterol levels, it does reduce triglyceride levels in the blood and raise the HDL level. Triglyceride is a measure fat in the blood. It usually has implications on total cholesterol levels. Fish oil is so effective it has been made into a drug by GlaxoSmithKline called Lovaza. It is ridiculously expensive at $175 for a one month supply. (Read my blog about it here.) The dose offered from Lovaza is also much too low at 1 gram per day. An effective dose is about 4-6 grams per day. You should also buy this through a reputable nutrition company as many cheap brands contain mercury, PCBs and other toxins. (Read my blog about that here.) A one month supply of a quality fish oil will probably cost between $25-$35 depending on how much you need to take. Much better than $175!
Lowering cholesterol by itself is not a full proof plan for protection against heart disease. It must be part of a total approach because high cholesterol by itself is not dangerous. However, it is useful if you lower your other risk factors. My advice to my patients is not to rely solely on a pill if you want to reach your goal. You must change your diet as well. Low carb, as mentioned above, is the way to go. If you combine the best of these two approaches you should be able to hit your target cholesterol in no time.
The article below is from the NY Times. See my comments at the end of the article.
NY Times Article
Eating about two and a half airplane snacks’ worth of nuts every day helps lower total cholesterol and “bad” LDL cholesterol, and improves the ratio of total cholesterol to “good” HDL cholesterol, a study reports.
Researchers pooled the results of 25 clinical trials that involved 583 participants over all. The study reported that eating just 2.4 ounces of nuts of any kind was associated with declines of 10.2 milligrams per deciliter in bad cholesterol, a drop of about 7.4 percent, and 10.9 milligrams in total cholesterol, or 5.1 percent.
The study, which appeared in the May 10 issue of Archives of Internal Medicine, was partly financed by a nut-industry foundation, and two of the authors receive research money from other organizations representing the nut and peanut industries.
But the authors noted that some of the trials they analyzed had no corporate financing, yet came to similar conclusions.
“Nuts are rich in unsaturated fats, and that is a main driver in lowering cholesterol,” said the lead author, Dr. Joan Sabaté, a professor of nutrition at the School of Public Health at Loma Linda University in California. “They are the richest source of protein in the plant kingdom, and they also contain fiber and phytosterols, which compete with cholesterol to be absorbed. All these nutrients have been demonstrated to lower cholesterol.”
The effect was most pronounced among people with higher LDL cholesterol to begin with and among those who were not obese. The more nuts they ate, the greater the effect.
This is great information to get out there. We have all seen those commercials touting cereal as a way to lower cholesterol. I have never been a fan of that because telling people to eat cereal to lower their cholesterol is a slippery slope. There are a lot of consumers in this country who cannot or do not make the distinction between Coco Puffs and a high fiber, whole grain cereal that could potentially be good for you.
While some very basic cereals, like steel cut oats for example, may be good for you in moderation, the vast majority of cereal out there is a major contributor to obesity and high cholesterol in this country. Oatmeal, in some studies, has been shown to mildly lower cholesterol levels when eaten every day for two months, but I don’t advise that my patients eat oatmeal frequently.
I do, however, recommend that my patients consume nuts as often as possible. This new research gives me another reason to tell my patients to go nuts! The greatest thing about this is that the results showed that the more nuts people consumed the better they did!
The study has some weaknesses. For one it was financed partly by the nut industry. However, almost all studies done on pharmaceuticals are funded for the most part by the pharmaceutical industry itself. Despite that fact we are supposed to take what we see and hear about those studies as gospel. In my opinion this study would be a little more substantial if it were not funded by the nut industry, but the results seem reasonable and from my experience as a clinician it makes sense.
Secondly, they did not delineate what type of nuts people should be eating. For my patients I recommend that people consume all nuts with the exception of peanuts. Peanuts are highly inflammatory and contain a mold toxin called aflatoxin that can cause a litany of health issues. Almonds, cashews or walnuts are all better options.
The moral of the story is eat as many nuts as you can. They are great as snacks or as an addition to a salad. I eat them as often. The best way to make sure you get them in is to buy them in bulk and have them on hand where ever you are. Buy a bag for the house and one for work and keep them there. They stay fresh for a very long time when properly stored and provide a great boost of energy, are loaded with vitamins and mineral and now help you lower your cholesterol. It’s a miracle food!
A new study recently published in today’s Journal of the American Medical Association has concluded that sugar intake significantly contributes to ill-health and specifically increases cholesterol levels.
Researchers at Emory University and the Centers for Disease Control and Prevention in Atlanta examined the added sugar intake and blood fat levels in more than 6,100 adults.
Added sugars included table sugar, brown sugar, high-fructose corn syrup, honey, molasses, brown rice syrup, agave syrup and other caloric sweeteners in prepared and processed foods — for instance, in soft drinks, iced tea, candy, pastries, cookies and canned fruits. Not included: the sugars in fruit, 100% juice and other whole foods.
These statistics are truly amazing. Most people are completely unaware of the amount of sugar in their diets. Remember, this is considered “added” sugar. This does not take into account the naturally occurring sugar in fruits, fruit juices and other whole foods as mentioned above.
While fruits are good for you and I do recommend that people consume them, I never recommend that people consume fruit juices. That is a huge source of sugar for most people and unfortunately they consider sitting down and drinking a glass of orange juice as healthy. There are worse things you could do, but there are also better things you could do for your health (like not drink it).
Consider that there is about as much sugar in a glass of OJ as there is in a soda. Fruit is different than fruit juice. Human beings we were designed to sit down and have one apple or one orange. We were never intended to sit down and eat 3 or 4 whole apples or oranges – the amount of fruit that it would take to get the sugar content of one glass of fruit juice.
Senior author Miriam Vos, an assistant professor at Emory say, “People have been so focused on fat that we haven’t been focused on sugar, and it’s gotten away from us. This data show we can’t let either one or the other get too high.” I don’t agree. The statement would read correctly if it said that traditional medicine has been so focused on fat that they forgot to look at sugar. Many functionally trained physicians including chiropractors, naturopaths and certified clinical nutritionists have been saying sugar is a huge culprit for years.
I see it routinely in my practice. People come to me with high cholesterol, weight issues, diabetes, high blood pressure and other health issues and the first thing I do is cut out the sugar and carbohydrates. They continue to eat healthy fats and proteins. They lose weight, improve cholesterol profiles, reduce their blood pressure and their diabetes disappears. It is simple physiology.
It would make sense that fat makes you fat, but like most things in medicine the obvious is often times not the answer. This holds true in this instance as well. People need to take responsibility and be aware of just how much carbohydrate they are putting into their bodies. After all, carbohydrates, not just simple sugars are contributing to this problem.
The American Heart Association is recommending that women get no more than 6.5 teaspoons of added sugar per day and men get no more than 9.5 teaspoons per day. While I still view this is high (because people often have other sources of naturally occurring sugar in their diet) it’s a good start. Remember, the average participant in the study consumed a whopping 21.4 teaspoons of added sugars a day! That is astronomical. Imagine sitting down at breakfast, lunch and dinner and shoveling in 7 teaspoons of sugar at each meal. You probably wouldn’t do that because you’d view it as terribly unhealthy yet the average person does it every day without even knowing it!
Sugar consumption in this country is out of control and as a person that works in the health field I have been well aware of it. Unfortunately, I think traditional medicine will continue to teach the low fat mantra that has led so many to be so sick in this country. The numbers are finally there. I can only hope people will take this health threat seriously and something will be done about the amount of added sugar that is in our diets.
Zetia, a cholesterol-lowering drug prescribed to about 1 million people each week, has no medical benefits, according to a trial by Merck and Schering-Plough.
While the pill does lower cholesterol by 15 percent to 20 percent, trials have not shown that Zetia reduces heart attacks or strokes, or that it reduces plaques in arteries that can lead to heart problems.
The current trial, which studied whether Zetia could reduce the growth of plaques, found that plaques grew nearly twice as fast in patients taking Zetia along with Zocor than in those taking Zocor alone.
Patients who took both Zetia and Zocor received it in the form of Vytorin, a pill that combines the medications.
Experts have called the results “shocking,” saying that Zetia should not be prescribed unless all other cholesterol drugs have failed.
The results also add to the controversy over Merck and Schering-Plough’s delays in releasing them. The trial was completed in April 2006, with results scheduled to be released in March 2007. However, the companies missed several deadlines, and only agreed to release the results after media outlets focused on their continued delays.
Zetia and Vytorin account for about 20 percent of the cholesterol drugs on the U.S. market.
Dr. Court’s Comments
It never ceases to amaze me that drugs that sell billions actually have no proven benefit. While it is true that this drug will lower total cholesterol, this does not correlate to a reduction in heart attack or stroke, as the maker implies in its advertising. This, however, makes sense with what is known about cholesterol. Many studies have been done that show arbitrarily lowering cholesterol is not an effective way to reduce cardiovascular risk. The makers of the statin class of drugs prefers that you don’ t know that though. Total cholesterol is meaningless. Most laboratories recommend that cholesterol be under 200, but studies show that just as many people with cholesterol under 200 have heart attacks as people with cholesterol above 200. So what does this mean? This means that there is another factor at work and to give people more drugs to lower cholesterol is irresponsible! The factor that should be looked at is inflammation. Inflammation is what damages arteries and causes plaque build up on their walls. As a matter of fact, studies are being done to see if statins can actually lower inflammation as well. We all know the pharmaceutical industry will not let the “statin cash cow” go quietly into the night.
There are many natural solutions to lowering cholesterol, should it need to be lowered. Before you start a statin make sure you know the break down of the cholesterol particles. That is, the HDL (good) vs. LDL (bad). This ratio is much more important than the total number. Also, find out what your triglyceride number is. This also plays into the equation.