Dr. Greg Feinsinger

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February 24, 2014
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It’s not all about cholesterol, but cholesterol is important

All higher animals including humans have cholesterol, which is a key constituent in cell membranes, bile acids, and certain hormones. So we all need some cholesterol, most of which is made by the liver with some obtained from diet. When you have your “cholesterol checked,” usually a lipids profile is done, which includes total cholesterol, LDL (“lousy or bad cholesterol”), HDL (“healthy or good cholesterol”), and triglycerides.

When it comes to cholesterol, however, more is not better, because cholesterol contributes to plaque that causes atherosclerosis (hardening of the arteries), which is what causes heart attacks and strokes, peripheral vascular disease, and erectile dysfunction, among other things. Genetic factors can cause your liver to make too much cholesterol, as can eating saturated and trans fats. All seafood and animal products contain cholesterol, so eating these things can contribute to high cholesterol. Think of the LDL as garbage in your arteries, so if you have high LDL (too much garbage), you will have a problem with your arteries. Think of your HDL as garbage trucks, so you will also have a problem with your arteries if you don’t have enough garbage trucks. A high triglyceride level is usually associated with low HDL and this combination is a sign of prediabetes.

When you are born, your total cholesterol is well below 100 and your LDL is in the 30s and 40s. Populations in the world who eat only plant products continue to have these low numbers as they age, and they don’t get atherosclerosis and therefore don’t have heart attacks or strokes. Other mammals that don’t get atherosclerosis also have these low levels. However, most people on the S.A.D. (standard American diet) have relatively high cholesterol levels, and the most common causes of death in this and other Western societies are heart attacks and strokes.

Although there is a clear relationship between very high total cholesterol and LDL, and heart attacks and strokes, it turns out that 50 percent of these events occur in people with “normal cholesterol,” so it’s certainly not ALL about cholesterol. The missing piece of the puzzle we now know is inflammation. People with inflammatory diseases such as rheumatoid arthritis and ulcerative colitis have a much higher rate of heart disease. For most of us, inflammation comes from dental problems/gum disease.

To lower your cholesterol, consider going on a total plant-based, low-fat diet. To find out more about this, watch the “Forks Over Knives” documentary DVD, read Dr. Esselstyn’s book “Prevent and Reverse Heart Disease,” or go to his website www.heartattackproof.com. Some people think that they would be unable to switch to a plant-based diet, but let me remind you: Former President Bill Clinton did, and he credits the change with saving his life. This approach is certainly the safest, most effective, and side-effect-free thing you can do.

For genetic reasons, there will still be people whose cholesterol puts them at risk even with a perfect lifestyle, and for these people, and those unwilling to make significant lifestyle changes, medications are available. Statin drugs have been available for years and are very effective at lowering LDL. They also have a strong anti-inflammatory effect. Liver abnormalities are rare enough with statins that the FDA no longer recommends checking liver enzymes in people on statins. Some people have muscle aching on statins, which often goes away after adding vitamin D and the supplement CO-Q10.

Low HDL is also a risk factor for cardiovascular events, but so far there is no proof that raising it makes any difference. Niacin raises HDL as well as lowering LDL and triglycerides, and there are some older studies indicating that adding niacin to a statin lowers event risk significantly, but a few newer studies have questioned the benefit of niacin. The majority of people with low HDL/high triglycerides have prediabetes, which resolves with adequate weight loss.

We should all know our cholesterol numbers, but we should also know them in total body context. Remember that after the upcoming Valley View Hospital health fairs, there will be a gathering at the hospital where you can ask questions about your lab results.

Dr. Greg Feinsinger is co-director of the Heart Attack, Stroke and Diabetes Prevention Center at Glenwood Medical Associates. He is a native of the Roaring Fork Valley and has been in practice for more than 40 years. He is an international Grand Master cross country ski racer and a competitive runner. He is available for appointments for heart health evaluation, as is his co-director, Dr. David Lorah. Call Dr. Feinsinger at 970-945-8503.


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The Post Independent Updated Feb 24, 2014 11:32PM Published Feb 24, 2014 11:32PM Copyright 2014 The Post Independent. All rights reserved. This material may not be published, broadcast, rewritten or redistributed.