Dear Doctor,

My cholesterol lab values have been steadily increasing year after year.  I’m thinking about starting some medication but am interested in alternatives.  Do you have any suggestions?

                                                                                                CH, Billings

Dear CH,

You are quite correct to be concerned about elevated cholesterol.  High cholesterol, especially LDL type cholesterol, is associated with an increased risk for heart attack and stroke.  People with a family history of heart disease, who smoke, are diabetic, have high blood pressure or are over 60 years of age have an increased risk for heart disease.  This makes it vital to maintain optimal LDL cholesterol levels.

Cholesterol comes in two types: LDL (low density lipoprotein) and HDL (high density lipoprotein).  Combining these two gives us total cholesterol levels in the blood.  Cholesterol is vital to our body’s health and is used in every cell of the body as well as in the making of hormones.  It is so important, in fact, that our liver makes 80% of the cholesterol used in our body.  Only 20% comes from what we eat, primarily from saturated fat like meat, eggs and dairy.  LDL (“bad” cholesterol) is made by the liver for delivery to the cells.  HDL (“good” cholesterol) goes from the cells back to the liver for breakdown.  It is like a truck delivering goods to a warehouse.  If too much goes in to the warehouse and not enough comes out, there is a jam-up.  In the body, too much LDL cholesterol contributes to the formation of atherosclerosis which can cause heart attack and stroke.  When there is a genetic predisposition for high cholesterol, or factors that increase cholesterol in the body, such as smoking, diabetes, lack of exercise, nutritional deficiencies, excess saturated fat or deficient plant foods, this changes the balance of cholesterol towards high LDL and low HDL.  It is also important to be aware of a third lipid type in the blood called triglycerides.  Very elevated triglycerides are often a familial trait, but are significantly influenced by our diet.  Diets high in sugar and refined flour products tend to increase triglyceride levels and are associated with an increased risk of diabetes and heart disease as well.

If you are planning to visit a doctor to discuss cholesterol, you can expect to have a fasting blood sample drawn for a lipid panel.  This will measure total cholesterol, LDL, HDL and triglycerides.  The National Institute of Health (NIH) currently recommends that total cholesterol levels be less than 200, with LDL 100 mg/dl or less optimally.  HDL should be over 40 mg/dl and triglycerides should be less than 150.  These NIH guidelines from ATP III (Adult Treatment Panel, Third Consensus) determine what level of treatment, if any, is required based on an individuals LDL, age, and current risk factors.

According to the NIH, the first level recommends “Therapeutic Lifestyle Changes” (TLC).  These include decreasing dietary saturated fat, decreasing weight, increasing activity and increasing plant sterols and fiber.  The second level of treatment is with medications such as statin drugs (Lipitor, etc), bile acid sequestrants and nicotinic acid (niacin).  Depending on an individuals needs, a person may be recommended to institute TLC for 6-8 weeks.  If there is no change in cholesterol, then medication or supplements may be introduced in addition to TLC.  Of interest is a new study that came out this month in The Annals of Internal Medicine comparing the cholesterol-lowering effects of a low saturated fat diet vs. a low fat diet plus plenty of vegetables, legumes and whole grains.  The low saturated fat diet definitely reduced LDL cholesterol, but the low fat “plus” diet reduced it even more.  The conclusions state that “previous guidelines probably underestimated the potential LDL-lowering effects of diet.” It is also important to note that moderate exercise one hour five times per week has been proven to reduce the risk of heart disease.

As naturopathic physicians we see many people with high cholesterol.  It is often a simple matter of adjusting diet and exercise, but sometimes supplements, or even medication ay be needed.  Certain herbs, foods and nutritional supplements have been clearly shown to lower LDL cholesterol by as much as 25% while also increasing protective HDL.  Others, like fish oils, specifically lower triglycerides.  One supplement derived from red yeast rice works identically to statin type drugs, and was in fact, the originator for these medications.  In some instances conventional medication may be necessary.  For example, if a person has had a stroke, statin drugs can decrease the risk of having a second one, even with normal cholesterol levels.  However, in cases where medication is either unnecessary or not tolerated natural medicine has a great deal to offer.

In summary, there are options for people with high cholesterol.  Sometimes a trial of diet, exercise, herbs and supplements can be an effective way to help balance high cholesterol, while also improving overall health and well-being.