The Cholesterol Question – Part 1

by Clark Zimmerman, L.Ac.

Cholesterol is essential in a healthy body. It helps to maintain vascular health by acting as a sort of patch that repairs damage to the blood vessel walls. It is also utilized in the formation of hormones and in vitamin D synthesis. We all need cholesterol to stay healthy. We produce some cholesterol in the liver, but we also get some cholesterol from the good we eat. Cholesterol is divided into 2 types: LDL and HDL. LDL, or Low Density Lipoprotein, is often referred to as “bad cholesterol.” LDL is essentially a fat wrapped in a protein. IT circulates through the body until it is used by cells as needed. HDL, or High Density Lipoprotein, is often referred to as “good cholesterol.” It’s primary function is to collect old LDL that haas been partially used by body cells, or that has oxidized as a result of free radicals.

Both LDL and HDL can also be divided into several subsets. Research is suggesting that both HDL and LDL have different effects in the body depending on their size. Of the LDL molecules it is the smaller ones that seem to cause trouble. If a blood vessel is damaged by inflammation, small LDL molecules infilitrate the area and cause a greater inflammatory process, unlike larger LDL molecules which are often too big to enter the damaged area. When the smaller LDL cmolecules collect in an area they begin to stick together and cause a potential obstruction in the blood vessel, which can cause a stroke or coronary artery obstruction (also known as a heart attacked). The presence of this particular type of LDL is largely due to genetics, and difficult to treat with diet and exercise alone. It is also important to note that it is the presence of inflammation that makes people more susceptible to problems with circulation.

So even though 2 people may have identical levels of LDL in the body, they can be very different in their risk of developing cholesterol related complications. This is where new cholesterol screens, such as the Spectra Cell test can be very valuable. If someone has elevated cholesterol, but tests show that they have relatively low concentrations of the small LDL particles, they can generally lower their cholesterol with diet, exercise, and stress lowering practices. If they are male, have a lot of small LDL particles, and are showing signs of arterial disease or inflammation, then a statin might be a good treatment option. It has been said that women typically don’t respond well to statin drugs. There is some research that suggests that many people who get heart disease have LDL levels that are considered to be within the healthy range. So if cholesterol is the cheif culprit in cases of heart disease, why do so many people develop heart disease who have “normal” LDL levels? This can again be explained by the different substets of LDL and HDL. Perhaps a person’s LDL levels are considered “normal,” but they have a high concentration of the small LDL particles which are more problematic.

Finally, there has been some concern recently that Statin drugs are not just ineffective in some situations, but that they may also cause unwanted side-effects. Statins have been known to cause headaches, nausea, vomiting, constipation, diarrgea, rash, muscle pain, or weakness. There is some concern that Statins may also contribute to an increased incidence of cancer. While there is little evidence to suggest that statins cause cancer, there is increasing evidence that lower LDL levels can contribute to cancer formation, and thus some concern that statins could lead to an increase in cancer formation. So what do we make of all of this conflicting info? I would refer you to the advice of Dr. Stephen Sinatra:

Here’s what you have to remember if your standard cholesterol numbers are “high” and your doctor tells you to take a statin:

• Don’t do it. Ask your doctor to follow up with an AP or LPP test that determines your individual cholesterol fractions.

• If you are a male between the ages of 50 and 75 and have coronary artery disease, and the advanced test shows you have a predominance of small, dense LDL, go for the statin drug. It’s a good idea. Statin drugs are also anti-inflammatory, and that’s the powerful effect you are looking for, not the cholesterol-lowering activity. I say thumbs down on statins over the age of 75.

• If you are a woman, and do not have unhealthy levels of inflammatory types of cholesterol and inflammatory substances such as homocysteine, fibrinogen, and C-reactive protein, I would pass statins. I’ve been disappointed with the result. However, if you are a woman with arterial disease and have a profile of high inflammatory cholesterol and other substances, a statin may provide you benenfits as an anti-inflammatory agent.

• Male or female, do not take a statin on the basis of high Lp(a). Statins do not lower Lp(a). Your best bet to neutralize the inflammatory activity of Lp(a) is the B-complex vitamin Niacine (500mg – 2g daily) of the type that causes a flushing sensation along with 2-3g of Fish Oil and 100mg of Nattokinase. That’s my most potent cocktain for neutralizing Lp(a).

I believe that there are other methods of lowering inflammation that are less problematic than statins. Often inflammation is created by lifestyle choices such as poor diet, smoking, or environmental toxins. Besides avoiding substances or situations that cause inflammation, there are additional ways to lower inflammation naturally. I will discuss these, and some additional cholesterol lowering ideas in part 2 of this article in our next newsletter.

Resources
Clearing Up the Cholesterol Confusion, Townsend Letter, Vol. #311, June 2009. Pg 60-62.