Understanding Cholesterol

By Mike DuBose with Blake DuBose and Surb Guram, MD

 

How to Lower Cholesterol without Statin Drugs Series: Part 1 of 4

 

Cardiovascular disease is responsible for 1 in every 3 American deaths, and each year, more 610,000 people die of heart disease (including heart attacks), according to the US Department of Health and Human Services. The biggest risk factor leading to these deadly conditions is high cholesterol. In fact, according to the Cleveland Clinic, one of America’s top research hospitals for heart health, having high cholesterol increases not only the risk of heart disease, but also some of the other top causes of death, including stroke, Type 2 diabetes, and high blood pressure. In addition, recent studies by the University of California have shown that high levels of LDL cholesterol and low HDL may also be associated with dementia and Alzheimer’s disease.

According to the Mayo Clinic, the seven greatest risk factors for high cholesterol are:

• Smoking, which damages the walls of your blood vessels, prompting them to accumulate fatty deposits. Smoking also lowers your good cholesterol (HDL).
• Obesity, where people have a body mass index (BMI) of 30 or above and waist measurements of 40” or higher for men and 35” or higher for women. (See the CDC’s tools at www.cdc.gov/healthyweight/assessing/bmi for help calculating your BMI.)
• Poor diet high in cholesterol-producing items such as red meat, fast and processed foods, full-fat dairy products, and foods high in saturated and trans fats.
• Lack of exercise, which puts you at risk of higher cholesterol since exercise raises your good cholesterol and lowers the bad LDL.
• Diabetes, with high blood sugar levels damaging the lining of the arteries, lowering HDL, and raising LDL.
• Your genetic makeup and family history of heart disease, which may dictate the amounts of bad cholesterol your body makes and how fast it leaves your system.
• Stress and anger, which weaken the immune system and raise blood pressure. Researchers now believe that high cholesterol may be partly caused by a bodily reaction to stress where more energy is produced in the form of fatty acids and glucose. These substances require the liver to produce more LDL, and the body may be less likely to rid itself of the cholesterol while also triggering inflammatory processes.

Sometimes, the reason for high cholesterol is another organ that is operating incorrectly. For example, a thyroid that is underperforming (called hypothyroidism) and liver or kidney diseases can be some culprits. These outside causes can be difficult to diagnose, which is why you need a highly experienced internist to carefully examine any potential causes if you have high cholesterol.

A number of medicines have also been scientifically linked to elevated cholesterol levels. These drugs include: diuretics, beta blockers, estrogen, steroids, diabetic drugs, vitamin D supplements (in too large of a dosage), certain antidepressants, creatine, prednisone, progestin, and retinoids (for acne), to name just a few. Never stop taking any medications without consulting your physician or pharmacist, but if you have high cholesterol, you will want to thoroughly research any medications you are taking and see if they may be contributing. Drugs.com is an excellent source of research and offers a tool where you can cross-reference all of your medicines. I discovered which drugs impacted my cholesterol through an even simpler method: going to Google and asking the question: “Does (name of medicine) increase my cholesterol?” If high cholesterol is a possible side effect of one of your drugs, you won’t miss that fact by using this strategy!

Once you have done your research, speak to your doctor about your findings. He or she may want to try an alternative drug or provide tips on how to lower your cholesterol through other means.

Of course, having high cholesterol does not guarantee that you will experience heart disease, a heart attack or stroke, or any of these other frightening illnesses. Some people with excellent genetic protective factors live to old age with high cholesterol, while others with low cholesterol die prematurely. However, for most people, the higher your cholesterol, the more likely you are to experience a traumatic—and perhaps disabling or deadly—vascular event.

To understand why it’s important to lower cholesterol, it’s helpful to know more about what it is and where it comes from. Cholesterol is a waxy, odorless substance that is generated by the liver and also enters the body through the foods and liquids we consume. Some cholesterol is good for the body because it protects cells, helps the body to send messages back and forth, encourages the generation of Vitamin D, works with the gallbladder in the digestive process, and assists in building hormones such as estrogen and testosterone.

However, when cholesterol reaches high levels, it becomes a silent killer. When there is too much cholesterol in your bloodstream, it builds up on the walls of your arteries; over time, excessive amounts of plaque can cause atherosclerosis, or “hardening of the arteries.” The arteries become very narrow and blood flow to the heart is slowed down or blocked. When the flow ceases completely, a heart attack occurs. Blood flow to the brain is also impacted, diminishing the amount of oxygen reaching it, which can cause a stroke.

Unfortunately, there are no outward symptoms when high cholesterol is in its early stages. Without taking blood tests, people are often unaware they have it until more serious symptoms (including heart attacks, angina, chest pains, or stroke) occur. Sadly, the realization that they have high cholesterol comes far too late for many individuals.

Every year, you should undergo a thorough medical examination under the care of a doctor, preferably an internist who has been trained in advanced medical diagnosis. One of the most important tests for high cholesterol that you will want to ensure he or she performs on you is called a “lipoprotein profile.” This assessment is done while fasting, which means you must abstain from eating or drinking anything other than water for 12 hours beforehand. This will give your doctor an accurate reading of your cholesterol numbers. You will also want to ask for a C-reactive protein test, a blood test that measures inflammation in your arteries. (By the way, going on a healthy diet right before your blood tests will not significantly alter your results!)

There are two main types of cholesterol: HDL and LDL. Most cholesterol is LDL (low-density lipoprotein) cholesterol. LDL cholesterol is more likely to clog blood vessels because when it is attached to a protein, it travels away from the liver into the bloodstream, where it can stick to the blood vessels. Remember this culprit by referring to it as the “lousy cholesterol.” HDL (high-density lipoprotein) cholesterol carries the cholesterol back to the liver, where it is broken down. Remember it as the “healthy cholesterol.”

Another important type of lipid to consider (apart from cholesterol) is triglycerides. Triglycerides are different in that they are fats, while cholesterol is not a fat. Triglycerides mostly come from our diet, including alcohol, sugar, and highly caloric foods. While there is no definitive study demonstrating a direct link between high triglycerides and heart disease, high triglycerides are a risk factor for pancreatitis, so levels over 500 are generally treated.

LDL and HDL particles are different sizes, and the health effects of the differing types of particles has been a matter of intense study recently. Research shows that smaller, denser LDL cholesterol is inflammatory and toxic to blood vessels. Even more troubling is a high level of lipoprotein-a, or Lp(a)—the most dangerous blood lipid. Lp(a) is a specific type of small LDL cholesterol particle that inflames the blood and makes it sticky, and patients with Lp(a) are more prone to clotting. Standard cholesterol tests, however, won’t tell you about your HDL and LDL ratios or Lp(a). Therefore, ask your doctor for Vertical Auto Profile (VAP) and Lipoprotein Particle Profile (LPP) blood tests.

Secure copies of all your blood and other tests and store them in a file so you can monitor changes each year. (I made a chart of my results that I can review with my doctor when comparing tests over time.) You don’t need an appointment with your doctor to obtain copies of the tests; just call ahead to ask for the documents. You may have to sign a form to receive them, though.

Treatments vary based on your HDL, LDL, and triglyceride levels, so study each of the lipids and what you can do to get them to healthy levels. The more dangerous cholesterol particles that show up in your blood tests, the more aggressively you’ll need to treat your cholesterol—because the more you have, the greater your risk for cardiovascular disease, stroke, and death.

Your LDL is not measured directly; rather, it is calculated from your total cholesterol, HDL, and triglyceride levels. The calculation used to derive LDL is: LDL = total cholesterol – HDL – (20% of your triglycerides). For example, if your total cholesterol is 164, HDL is 65, and triglycerides are 75, your LDL comes out to be 84. Triglyceride levels are affected by food intake, which is why you must fast prior to blood testing to obtain an accurate lipid profile.

According to the American Heart Association, a total cholesterol score of 180 mg/dl or less is optimal (some physicians continue to use the former standard of 200 mg/dl or less), although the individual components are more important than the total cholesterol level. In terms of specific lipids, Cleveland Clinic and the Mayo Clinic both recommend shooting for an HDL of more than 40, LDL of 100 mg/dl or less, and triglycerides lower than 150 mg/dl.

Nowadays, doctors also consider risk factors such as diabetes, previous heart attacks or strokes, blockages, heart disease, family history, age, and other risk factors when establishing individual cholesterol goals. In fact, cholesterol usually increases as we age, but children as young as two years old can have high cholesterol! The American Academy of Pediatrics generally recommends first testing children for lipids between the ages of 9 and 11.

The bottom line: As with most things, when it comes to cholesterol, knowing is half the battle. Without awareness of your cholesterol levels and what they mean, you can’t know what steps you need to take to improve your health (or if you even have high cholesterol at all)! Therefore, we recommend thorough testing every year to help you understand your cholesterol counts and take any necessary actions if tests reveal that your cholesterol is high. Read the second segment in this four-part series, “How to Reduce Cholesterol through Lifestyle Changes,” to learn some easy ways you can help lower your cholesterol through simple changes to your daily routine.

 

About the Authors: Our corporate and personal purpose is to “create opportunities to improve lives” by sharing our knowledge, research, experiences, successes, and mistakes. You can e-mail us at [email protected].

 

Mike DuBose, a University of South Carolina graduate, is the author of The Art of Building a Great Business. He has been in business since 1981 and is the owner of Research Associates, The Evaluation Group, DuBose Fitness Center, and Columbia Conference Center. Visit his nonprofit website www.mikedubose.com for a free copy of his book and additional business, travel, health, and personal published articles.

 

Blake DuBose graduated from Newberry College’s Schools of Business and Psychology and is president of DuBose Web Group (www.duboseweb.com).

Katie Beck serves as Director of Communications for the DuBose family of companies. She graduated from the USC School of Journalism and Honors College.

 

Dr. Surb Guram, MD is a board-certified internist and a graduate of the University of South Carolina School of Medicine. He is a partner with the SC Internal Medicine Associates in Irmo, SC and has practiced internal medicine in the Midlands for the past 30 years. See www.scinternalmedicine.com for more information on Dr. Guram and his practice.

 

© Copyright 2015 by Mike DuBose—All Rights Reserved. You have permission and we encourage you to forward the full article to friends or colleagues and/or distribute it as part of personal or professional use, providing that the authors are credited. However, no part of this article may be altered or published in any other manner without the written consent of the authors. If you would like written approval to post this information on an appropriate website or to publish this information, please contact Katie Beck at [email protected] and briefly explain how the article will be used; we will respond promptly. Thank you for honoring our hard work!

 

 

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