Q:  Are there any supplements you recommend for treating cholesterol?
A:  Great question and yes, lots!!  Read on…
First we need to understand cholesterol.  Years ago the ranges for a “normal cholesterol” were above 250 and now they are diving lower and lower.  We are discovering so much about cholesterol almost daily so be sure and keep up-to-date on this ever changing field of lipidology.  Let’s start with the basics:  Total cholesterol is a number that includes LDL, triglycerides as well as HDL.  I don’t put much stock in the total cholesterol number because it’s the other numbers that are the real players. Let’s look at the good, the bad and the ugly concerning cholesterol.

THE GOOD:

HDL is considered the good form of cholesterol and you often hear that high levels off set the bad cholesterol.  Not all HDL is helpful though.  I describe HDL as pac-men. They go and gobble up the bad guys. If the HDL “pac-men” are large they can hold more bad guys, if they are small then they can’t hold very much.  So knowing the size of the particles as well as the number becomes important.    My goal is a HDL above 50 with large particles.

THE BAD:

LDL is the marker that has been shown to cause atherosclerosis but some LDL’s are worse than others.  The regular LDL number only tells you part of the picture.  Again, we go back to the particle size.  You need to know if you have small, sticky particles or large, clumsy ones.  Small and sticky particles find their way into our vessel lining very easily and help attract plaque.   Larger particles aren’t as bad because they just can’t squeeze into the membrane.   We don’t want very many LDL’s and we certainly don’t want them small and sticky.  My LDL goal is less than 130 with larger particles.

Triglycerides are a type of fat in your blood.  High triglycerides increase your risk of heart disease even if the LDL is normal.  Many foods contribute to high triglycerides including obviously high fat foods but you may not know that high fructose corn syrup and plain old sugar can raise triglycerides, too!  My triglyceride goal is less than 75.

THE UGLY:

LP(a):  There is another very important marker called Lp(a) which has a genetic component to it.  An elevation in Lp(a) even with completely normal cholesterol levels can put you at increased risk of atherosclerosis of the heart and the carotids.  It is very important to measure this and address it.  Many statins actually raise Lp(a) so be sure and discuss this with your physician.  Unfortunately, many physicians don’t know much about this marker.  The research on this is being published in cardiology journals so is actually main stream medicine!
All of these tests are available thru your regular lab but special profiles such as a VAP or NMR must be ordered to get the particle sizes & Lp(a).  
So what do you do about this?  If the evidence of the statin epidemic is any indication of the direction this country is going then the answer would be start a statin medication.  However, unless you have known heart disease or have had a heart attack in the past you have 3-6 months to try to turn your numbers around before rushing to this step.  So let’s talk about steps to work on.
  • Change your Diet:  Intake of saturated fats, high red meat intake, high processed foods all increase cholesterol so obviously lower the intake of these foods.  Beans, legumes and fiber all help bind up cholesterol and can help lower it, too.  Dramatic changes in cholesterol can be seen often with vegan diets.  Before you embark on that type of diet, get some help in doing it the correct way so you don’t deplete yourself of key nutrients.
  • Reduce Stress:  during times of high stress we make more cholesterol so it stands to reason if we can work on stress reducing techniques our cholesterol may respond. Stress is a huge factor in cholesterol production so do not ignore this!!
  • Exercise:  even 10 minutes twice a day has been shown to be of benefit.  Exercise increases the good HDL cholesterol.
Ask the Doctor:  Is Low Dose Naltrexone the answer for all of your inflammatory issues?
  • Supplements
    • Red Yeast Rice:  this can be very effective but be aware of the manufacturer because they are not all created equal.  This is basically a natural statin and is very similar to Lipitor. You still have to watch for muscle aches like the statins but in my experience with the combination products I use I rarely have people not tolerate this.   Always take Coenzyme Q if you take this.
    • Fish oil:  fish oil will help lower the triglycerides and is always my first line treatment for high triglyceride levels.  You need a really good quality fish oil with a high dose per capsule (look for at least 700mg of active EPA/DHA in each capsule or more).  You can read your fish oil label by turning to the back and adding the amount of EPA and the amount of DHA.  Now you have the total active fish oil per serving size.  I aim for a starting point of 2000 mg of active components.  Of note, fish oil doesn’t do much for the LDL’s.
    • Tocotrienols:  tocotrienols are a specialized form of vitamin E which help prevent the oxidation of the LDL’s which means it can help small, sticky LDL’s become larger and not be as bad for you.  Don’t take any regular vitamin E anywhere near this one because then it won’t work.
    • Policosanol:  this has been reported to help lower cholesterol.  I have rarely seen this work but every once in a while I see if you are the person it does work in it is easy to take without any major side-effects.
    • Pantethine:  this is a derivative of B5 that has been shown to help lower cholesterol.  Interestingly, B5 if a key nutrient the adrenals, our stress gland. Hmm, back to the stress theory….
    • Artichoke leaf:  this has been felt to raise HDL and may help with lowering LDL in some people.

 Best ways to treat Lp(a):

    • Niacin – Niacin can cause some wicked flushing and prickly sensations.  Taking applesauce or a baby aspirin 30 minutes prior to the niacin can really help.
    • Omega Krill by Xymogen – this has an ingredient that is not processed out that my help lower these levels.  Regular krill oil does not have this ingredient.
Obviously, there are many other ways to lower cholesterol!  I need to mention that if you have Familial Hypercholesterolemia (FH) there is a special new medication used to treat this that is not a statin.  If you have a LDL above 180 you might have FH so ask your primary care physician about treatment options.