Lowering Your Cholesterol

This article is a basic article on cholesterol metabolism and
treatment. For a more advanced version please click here.

                                                  ♥ Atherosclerosis♥

As we get older our blood vessels harden. There are many reasons for this. One of the main reasons is too
much cholesterol. Too much cholesterol leads to hardening and narrowing of the blood vessels (arteries),
with eventual closure. This causes heart attacks, strokes, kidney failure, and circulation problems of the legs.
Some lipid abnormalities are inherited whereas others develop as we age and are more easily modifiable
with diet and exercise whereas inherited lipid abnormalities often require treatment with medications.

We routinely perform screening cholesterol tests in our office. However, many patients with normal lipid
panels who have other risk factors for heart disease or have strong family histories require more extensive
testing. Some of these additional testing we perform in our office. For more specialized testing we obtain
blood in our office and send samples Spectracell laboratory in Texas where the most sophisticated lipid
analysis in the world is now being performed. This is referred to as the LPP panel. Through this additional
testing we can accurately determine the need for specific and definitive treatment for those with abnormal
lipid panels or with completely normal traditional cholesterol panels who either have had heart disease or
have strong family histories of cardiovascular disease. On occasion we also perform non-fasting lipid panels
as mid day non-fasting elevated triglycerides are now considered an independent risk factor for
cardiovascular disease. Additonal tests we use to determine need for intervention include:  Hemoglobin
A1C, C-reactive protein, lipoprotein (b), homocysteine, Hemoglobin A1C, Glycomark, c-peptide, LP(a), RLP-
PLA2, sub-fractionating HDL and LDL, liporpotein A and B, carotid ultrasound.  











What is cholesterol?

Cholesterol is a waxy, fat like substance (lipid) that your body needs for many important functions, such as
producing new cells. But too high a level of cholesterol in the blood is detrimental to your health.
You get cholesterol in two ways. Your body makes some of it, and the rest comes from cholesterol in animal
products that you eat, such as meats, poultry, fish, egg yolks, butter, cheese and whole milk.

Good vs. Bad cholesterol

Low-density lipoprotein cholesterol (LDL) is called "bad" cholesterol because it can cause cholesterol
buildup and blockage of your arteries. High-density lipoprotein cholesterol (HDL) is sometimes called "good"
cholesterol because it helps prevent cholesterol from building up in your arteries.

More sophisticated cholesterol testing determines how good and protective HDL can be and how harmful
LDL can be. LPP panel, non-fasting cholesterol panels, direct imaging of arteries by carotid ultrasound and
functional testing such as stress testing are other more definitive ways of assessing risk for heart disease.


What causes high cholesterol?

Several factors can cause high cholesterol. Some risk factors can be controlled; others can't.

♥ Risk factors you can change without medications: include sedentary life style, elevated blood sugars
(poorly controlled diabetes), tobacco use, obesity, and eating a diet high in saturated fat and cholesterol
♥ Risk factors you can not change without medications: include genetic predisposition, (familial hyper-
lipidemia), age and gender.

How can I lower my cholesterol?

There are two basic ways of lowering your cholesterol: modifying your lifestyle and/or taking medications.
Your doctor may first recommend lifestyle changes, such as modifying your diet, smoking cessation, losing
weight, and exercising.  

    Lifestyle modifications

Diet: Saturated fat and cholesterol in the food you eat make your blood cholesterol level go up. Saturated
fat is the main culprit, but cholesterol in foods also matters.

Weight: Obesity is a risk factor for heart disease. Losing weight can help lower your bad cholesterol and
triglycerides and raise your good cholesterol.

Physical Activity: A sedentary life style is a risk factor for heart disease. Regular physical activity can
help lower bad cholesterol and raise HDL good cholesterol levels. You should try to be physically active for
30 minutes on most, if not all, days. Try walking, biking, or swimming. What activity is good activity? ANY
ACTIVITY IS GOOD ACTIVITY! Even if you’re just sitting around try flexing and extending your arms and
legs, it’s better than nothing!

Stop smoking: Smoking decreases "good" HDL cholesterol and changes bad cholesterol so that it
promotes the buildup of deposits on the walls of your coronary arteries. It also causes the arteries to spasm
thus making them more likely to close.

Supplements: Lipids from natural sources that contain high levels of omega-3 fatty acids can replace
the saturated fats that raise cholesterol levels. These natural supplements are concentrated oils from fish
and flax seed. Because of high mercury levels in some fish due to environmental pollution I recommend one
flax seed oil capsules with each meal over fish oil. The main side effect of flax seed is belching that can be
eliminated if the capsules are kept in the freezer. Flax seed oil can also be used to make salad dressing but
cooking destroys its beneficial effects on cholesterol levels. There is also a golden flax cereal available at
Trader Joe’s. Flax seed capsules can be found at most drug stores and supermarkets. Unlike most
alternative therapies, flax seed has been shown in randomized medical trials to effectively lower triglyceride
and cholesterol levels by 10-20%.