Cholesterol Control

Hyperlipidemia, which is elevated cholesterol, is a major risk factor for
cardiovascular disease. When your cholesterol level is elevated you are more
likely to develop plaque formation in your arteries, resulting in decreased
blood flow to your organs and an elevated blood pressure. This condition is also
a risk factor for dementia, kidney disease and blindness. LDL (bad) cholesterol
is what lays plaque in your arteries. HDL (good) cholesterol picks up LDL
cholesterol and returns it to your liver. Whether or not your cholesterol is
elevated is related to both lifestyle (diet and exercise) and genetic
(hereditary) factors. You can not change your genetics, but you do have control
of your lifestyle choices.

Goals:
LDL – <100 (<70 if you have diabetes or cardiovascular disease).
The lower the better.
HDL – >45 for men, >50 for women. The higher the better.
Triglycerides – <150. Triglycerides are a by-product of
carbohydrate metabolism and often become elevated with diabetes. Elevated
triglycerides also cause cardiovascular disease.

Here are some tips to lower your LDL and raise your HDL cholesterol:

Diet – Your diet should consist of high fiber foods such as
vegetables, fruits, legumes and whole grains. Fish has also been shown to lower
LDL. So try to eat fish at least twice a week. A Mediterranean diet has been
shown to be heart healthy because of its emphasis on fish, vegetables and whole
grains. Choose lean meats and non-fat or low-fat dairy, while minimizing your
consumption of beef (three times weekly or less), fatty foods and
sugars/starches (sweets, chips, white bread, rice, potatoes, pasta, etc.). Nuts,
such as almonds (6/day) have also been shown to be helpful. Incorporate fiber
such as oat bran and flax seed into your diet daily. As fiber transits through
the intestine it pulls cholesterol out of the bile acid and into your stool. Use
monounsaturated oils such as canola or olive oil, but use oils minimally. A
serving of red wine (4 ounces) daily has been shown to lower LDL. Limit wine
consumption to 4-7 servings per week.

Exercise – Incorporate 30-60 minutes of exercise, 5-7 times
per week into your schedule. Exercise will help with weight loss, lower your
LDL, raise your HDL and lower your triglycerides.

Weight loss – If your BMI (body mass index) is >27, then
weight loss will help improve your lipid profile. Go to www.americanheart.org to
calculate your BMI.

Fish Oil – Omega fish oil has been shown to lower LDL and
triglycerides, as well as reduce the incidence of heart disease. You need to
take 3-9grams daily (some authorities recommend no more than 5 grams daily) to
get benefit from this supplement. If the fishy taste bothers you take it at
night or buy the enteric coated version. The Kirkland brand at Costco was rated
as a best buy by Consumer Reports. Flax seed can be used as a secondary
alternative if you can not take fish oil.

Red Yeast Rice – This supplement has been shown to modestly
lower LDL and triglycerides. Dosing is 1200mg twice daily. This supplement is
usually well tolerated, but talk to your health care provider. You will want to
have periodic blood tests to monitor your liver if taking this supplement.

Niacin – Niacin may be used to raise HDL and lower LDL. Make
sure you talk to your health care provider before taking this medication as you
will need to have your liver monitored. The usual dosing on Niacin is 1-2grams
daily, but it is usually started at lower doses, due to it’s flushing effect. To
reduce flushing take 81 mg of aspirin (as long as you’re not allergic to
aspirin) 30 minutes before you take the Niacin. This flushing effect usually
resolves within a couple of weeks, as your body adjusts to the Niacin. Avoid
“No-Flush” branded Niacin as it is Niacinamide and it doesn’t do anything to
lower your cholesterol. Slow-release types Niacin are a little pricier, but
usually have less flushing.

Benecol – Benecol can be found in the margarine section in
the brands of Smart Balance and Take Control artificial margarines. Benecol has
been found to lower LDL if used in moderation.

Psyllium (Metamucil)– Psyllium is a water soluble fiber and
has been shown to reduce LDL if taken daily. Make sure you drink at least 8
ounces of water when you take this supplement.

Medications
If you are unable to get your lipid profile to goal after 6 months of lifestyle
changes, you may benefit from taking a prescription medication. There are
several types of cholesterol medications, with the statins being the most potent
in dropping LDL. Numerous studies have shown significant drops in risks for
heart attacks and strokes for patients who take statins. Statins can have side
effects and you do need to have periodic blood tests to monitor your liver
function. However, the overall benefit of this type of medication is so
significant your health care provider will try to find a medication that will
work for you. Life expectancy has increased 10 years in the last 20 years,
primarily by dropping people’s blood pressure and cholesterol via medical
treatment. So don’t ignore medications as they are a powerful tool to not only
increase your life expectancy, but to also improve quality of life as you age.