WE HAVE ALL BEEN LED TO to believe that cholesterol is bad and that lowering it is good. Because of extensive pharmaceutical marketing to both doctors and patients we think that using statin drugs is proven to work to lower the risk of heart attacks and death.
But on what scientific evidence is this based, what does that evidence really show?
Roger Williams once said something that is very applicable to how we commonly view the benefits of statins. “There are liars, damn liars, and statisticians.”
We see prominent ads on television and in medical journals — things like 36% reduction in risk of having a heart attack. But we don’t look at the fine print. What does that REALLY mean and how does it affect decisions about who should really be using these drugs.
Before I explain that, here are some thought provoking findings to ponder.
- If you lower bad cholesterol (LDL) but have a low HDL (good cholesterol) there is no benefit to statins. (i)
- If you lower bad cholesterol (LDL) but don’t reduce inflammation (marked by a test called C-reactive protein), there is no benefit to statins. (ii)
- If you are a healthy woman with high cholesterol, there is no proof that taking statins reduces your risk of heart attack or death. (iii)
- If you are a man or a woman over 69 years old with high cholesterol, there is no proof that taking statins reduces your risk of heart attack or death. (iv)
- Aggressive cholesterol treatment with two medications (Zocor and Zetia) lowered cholesterol much more than one drug alone, but led to more plaque build up in the arties and no fewer heart attacks. (v)
- 75% of people who have heart attacks have normal cholesterol
- Older patients with lower cholesterol have higher risks of death than those with higher cholesterol. (vi)
- Countries with higher average cholesterol than Americans such as the Swiss or Spanish have less heart disease.
- Recent evidence shows that it is likely statins’ ability to lower inflammation it what accounts for the benefits of statins, not their ability to lower cholesterol.
So for whom do the statin drugs work for anyway? They work for people who have already had heart attacks to prevent more heart attacks or death. And they work slightly for middle-aged men who have many risk factors for heart disease like high blood pressure, obesity, or diabetes.
So why did the 2004 National Cholesterol Education Program guidelines expand the previous guidelines to recommend that more people take statins (from 13 million to 40 million) and that people who don’t have heart disease should take them to prevent heart disease. Could it have been that 8 of the 9 experts on the panel who developed these guidelines had financial ties to the drug industry? Thirty-four other non-industry affiliated experts sent a petition to protest the recommendations to the National Institutes of Health saying the evidence was weak. It was like having a fox guard the chicken coop.
People with the lowest cholesterol as they age are in fact at highest risk of death. Under certain circumstances, higher cholesterol can actually help increase life span.
It’s all in the spin. The spin of the statistics and numbers. And it’s easy to get confused. Let me try to clear things up.
When you look under the hood of the research data you find that the touted “36% reduction” means a reduction of the number of people getting heart attacks or death from 3% to 2% (or about 30-40%).
And that data also shows that treatment only really works if you have heart disease already. In those who DON’T have documented heart disease, there is no benefit.
In those at high risk for heart disease about 50 people would need to be treated for 5 years to reduce one cardiovascular event. Just to put that in perspective: If a drug works, it has a very low NTT (number needed to treat). For example, if you have a urine infection and take an antibiotic, you will get near a 100% benefit. The number needed to treat is “1″. So if you have an NTT of 50 like statins do for preventing heart disease in 75% of the people who take them, it is basically a crap shoot.
Yet at a cost of over $28 billion a year, 75% of all statin prescriptions are for exactly this type of unproven primary prevention. Simply applying the science over 10 years would save over $200 billion. This is just one example of reimbursed but unproven care. We need not only prevent disease but also prevent the wrong type of care.
If these medications were without side effects, then you may be able to justify the risk – but they cause muscle damage, sexual dysfunction, liver and nerve damage and other problems in 10-15% of patients who take them. Certainly not a free ride.
So if lowering cholesterol is not the great panacea that we thought, how do we treat heart disease, and how do we get the right kind of cholesterol – high HDL, low LDL and low triglycerides and have cholesterol particles that are large, light and fluffy rather than small, dense and hard, which is the type that actually causes heart disease and plaque build up.
We know what causes the damaging small cholesterol particles. And it isn’t fat in the diet. It is sugar. Sugar in any form or refined carbohydrates (white food) drives the good cholesterol down, cause triglycerides to go up, creates small damaging cholesterol particles, and causes metabolic syndrome or pre-diabetes. That is the true cause of most heart attacks, NOT LDL cholesterol.
One of the reasons we don’t hear about this is because there is no good drug to raise HDL. Statin drugs lower LDL — and billions are spent advertising them, even though they are the wrong treatment.
If you’re like most of the patients I see in my practice, you’re convinced that cholesterol is the evil that causes heart disease. You may hope that if you monitor your cholesterol levels and avoid the foods that are purported to raise cholesterol, you’ll be safe from America’s number-one killer.
We are all terrified of cholesterol because for years well-meaning doctors, echoed by the media, have emphasized what they long believed is the intimate link between cholesterol and death by heart disease. If only it were so simple!
The truth is much more complex.
Cholesterol is only one factor of many — and not even the most important — that contribute to your risk of getting heart disease.
First of all, let’s take a look at what cholesterol actually is. It’s a fatty substance produced by the liver that is used to help perform thousands of bodily functions. The body uses it to help build your cell membranes, the covering of your nerve sheaths, and much of your brain. It’s a key building block for our hormone production, and without it you would not be able to maintain adequate levels of testosterone, estrogen, progesterone and cortisol.
So if you think cholesterol is the enemy, think again. Without cholesterol, you would die.
In fact, people with the lowest cholesterol as they age are at highest risk of death. Under certain circumstances, higher cholesterol can actually help to increase life span.
In reality, the biggest source of abnormal cholesterol is not fat at all — it’s sugar. The sugar you consume converts to fat in your body. And the worst culprit of all is high fructose corn syrup.
To help clear the confusion, I will review many of the cholesterol myths our culture labors under and explain what the real factors are that lead to cardiovascular disease.
Cholesterol Myths
One of the biggest cholesterol myths out there has to do with dietary fat. Although most of us have been taught that a high-fat diet causes cholesterol problems, this isn’t entirely true. Here’s why: The type of fat that you eat is more important than the amount of fat. Trans fats or hydrogenated fats and saturated fats promote abnormal cholesterol, whereas omega-3 fats and monounsaturated fats actually improve the type and quantity of the cholesterol your body produces.
In reality, the biggest source of abnormal cholesterol is not fat at all — it’s sugar. The sugar you consume converts to fat in your body. And the worst culprit of all is high fructose corn syrup.
Consumption of high fructose corn syrup, which is present in sodas, many juices, and most processed foods, is the primary nutritional cause of most of the cholesterol issues we doctors see in our patients.
So the real concern isn’t the amount of cholesterol you have, but the type of fats and sugar and refined carbohydrates in your diet that lead to abnormal cholesterol production.
Of course, many health-conscious people today know that total cholesterol is not as critical as the following:
- Your levels of HDL “good” cholesterol vs. LDL “bad” cholesterol
- Your triglyceride levels
- Your ratio of triglycerides to HDL
- Your ratio of total cholesterol to HDL
Many are also aware that there are different sizes of cholesterol particles. There are small and large particles of LDL, HDL, and triglycerides. The most dangerous are the small, dense particles that act like BB pellets, easily penetrating your arteries. Large, fluffy cholesterol particles are practically harmless–even if your total cholesterol is high. They function like beach balls and bounce off the arteries, causing no harm.
Another concern is whether or not your cholesterol is rancid. If so, the risk of arterial plaque is real.
Rancid or oxidized cholesterol results from oxidative stress and free radicals, which trigger a vicious cycle of inflammation and fat or plaque deposition under the artery walls. That is the real danger: When small dense LDL particles are oxidized they become dangerous and start the build up of plaque or cholesterol deposits in your arteries.
Now that we’ve explored when and how cholesterol becomes more problematic, let’s take a look at other factors that play a more significant role in cardiovascular disease.
Prime Contributors to Cardiovascular Disease
First of all, cardiovascular illness results when key bodily functions go awry, causing inflammation, (vii) imbalances in blood sugar and insulin and oxidative stress.
To control these key biological functions and keep them in balance, you need to look at your overall health as well as your genetic predispositions, as these underlie the types of diseases you’re most likely to develop. It is the interaction of your genes, lifestyle, and environment that ultimately determines your risks — and the outcome of your life.
This is the science of nutrigenomics, or how food acts as information to stall or totally prevent some predisposed disease risks by turning on the right gene messages with our diet and lifestyle choices. That means some of the factors that unbalance bodily health are under your control, or could be.
These include diet, nutritional status, stress levels, and activity levels. Key tests can reveal problems with a person’s blood sugar and insulin, inflammation level, level of folic acid, clotting factors, hormones, and other bodily systems that affect your risk of cardiovascular disease.
Particularly important are the causes if inflammation, which are many, and need to be assessed. Inflammation can arise from poor diet (too much sugar and trans and saturated fats), a sedentary lifestyle, stress, autoimmune disease, food allergies, hidden infections such as gum disease, and even toxins such as mercury. All of these causal factors need to be considered anytime there is inflammation.
Combined together, all of these factors determine your risk of heart disease. And I recommend that people undergo a comprehensive medical evaluation to see what their risk really is.
Zeroing in on Key Factors for Heart Disease
There’s no doubt about it, inflammation is key contributor to heart disease. A major study done at Harvard found that people with high levels of a marker called C-reactive protein (CRP) had higher risks of heart disease than people with high cholesterol. Normal cholesterol levels were NOT protective to those with high CRP. The risks were greatest for those with high levels of both CRP and cholesterol.
Another predisposing factor to heart disease is insulin resistance or metabolic syndrome, which leads to an imbalance in the blood sugar and high levels of insulin. This may affect as many as half of Americans over age 65. Many younger people also have this condition, which is sometimes called pre-diabetes.
Although modern medicine sometimes loses sight of the interconnectedness of all our bodily systems, blood sugar imbalances like these impact your cholesterol levels too. If you have any of these conditions, they will cause your good cholesterol to go down, while your triglycerides rise, which further increases inflammation and oxidative stress. All of these fluctuations contribute to blood thickening, clotting, and other malfunctions — leading to cardiovascular disease.
What’s more, elevated levels of a substance called homocysteine (which is related to your body’s levels of folic acid and vitamins B6 and B12) appears to correlate to cardiovascular illness. Although this is still somewhat controversial, I often see this inter-relationship in my practice. While genes may play a part, tests done as part of a comprehensive evaluation of cardiac risk can easily ascertain this factor. Where problematic levels occur, they can be easily addressed by adequate folic acid intake, along with vitamins B6 and B12.
Testing for Cardiovascular Risk Factors
Heart disease is not only about cholesterol. It is important to look at many factors that contribute to your overall risk. And it seems that insulin and blood sugar imbalances, and inflammation are proving to be more of a risk that cholesterol.
If you want to test your overall risk, you can consider asking your doctor to perform the following tests:
- Total cholesterol, HDL cholesterol, LDL cholesterol, and triglycerides. Your total cholesterol should be under 200. Your triglycerides should be under 100. Your HDL should be over 60. Your LDL should be ideally under 80. Your ratio of total cholesterol to HDL should be less than 3.0. Your ratio of triglycerides to HDL should be no greater than 4, which can indicate insulin resistance if elevated.
- NMR Lipid Profile. This looks at your cholesterol under an MRI scan to assess the size of the particles, which can determine your cardiovascular risk. This is a very important test that can further differentiate the risk of your cholesterol and can be an important factor to track as your system improves and your cholesterol transforms from being small dense and dangerous to light and fluffy and innocuous. It is done by a company called Liposcience and is also available through LabCorp.
- Glucose Insulin Tolerance Test. Measurements of fasting and 1 and 2 hour levels of glucose AND insulin helps identify pre-diabetes and excessively high levels of insulin, and even diabetes. Most doctors just check blood sugar and NOT insulin, which is the first thing to go up. By the time your blood sugar goes up, the train has left the station.
- Hemaglobin A1c. This measures your average blood sugar level over the last 6 weeks. Anything over 5.5 is high.
- Cardio C-reactive protein. This is a marker of inflammation in the body that is essential to understand in the context of overall risk. Your C-reactive protein level should be less than 1.
- Homocysteine. Your homocysteine measures your folate status and should be between 6 and 8.
- Lipid peroxides or TBARS test, which looks at the amount of oxidized or rancid fat. This should be within normal limits of the test and indicates whether or not you have oxidized cholesterol.
- Fibrinogen, which is another test looking at clotting in the blood. It should be less than 300.
- Lipoprotein (a), which is another factor that can promote the risk of heart disease, often in men. It should be less than 30.
- Genes or SNPs may also be useful in terms of assessing your situation. A number of key genes regulate cholesterol and metabolism, including Apo E genes and the cholesterol ester transfer protein gene. The MTHFR gene, which regulates homocysteine is also important and may be part of an overall workup.
- Get a high-speed CT or (EBT) scan of the heart if you are concerned that you have cardiovascular disease. This may be helpful to assess overall plaque burden and calcium score. A score higher than 100 is a concern, and a score higher than 400 indicates severe risk of cardiovascular disease.
Next I will review how to lower your risk of heart disease and fix your cholesterol. We’ll do this not by lowering the LDL, but by getting more light and fluffy LDL particles, which are protective and more HDL cholesterol, which is THE most important cholesterol.
Now I’d like to hear from you…
Have you been told that you need to lower your cholesterol?
If so, what were your told to do and how does that compare to what you’ve read here?
Does any of what you’ve read here come as a surprise?
Please share your thoughts by adding a comment below.
References
(i) Barter P, Gotto AM, LaRosa JC, Maroni J, Szarek M, Grundy SM, Kastelein JJ, Bittner V, Fruchart JC; Treating to New Targets Investigators. HDL cholesterol, very low levels of LDL cholesterol, and cardiovascular events. N Engl J Med. 2007 Sep 27;357(13):1301-10.
(ii) Ridker PM, Danielson E, Fonseca FA, Genest J, Gotto AM Jr, Kastelein JJ, Koenig W, Libby P, Lorenzatti AJ, MacFadyen JG, Nordestgaard BG, Shepherd J, Willerson JT, Glynn RJ; JUPITER Study Group. Rosuvastatin to prevent vascular events in men and women with elevated C-reactive protein. N Engl J Med. 2008 Nov 20;359(21):2195-207.
(iii) Abramson J, Wright JM. Are lipid-lowering guidelines evidence-based? Lancet. 2007 Jan 20;369(9557):168-9
(iv) IBID
(v) Brown BG, Taylor AJ Does ENHANCE Diminish Confidence in Lowering LDL or in Ezetimibe? Engl J Med 358:1504, April 3, 2008 Editorial
(vi) Schatz IJ, Masaki K, Yano K, Chen R, Rodriguez BL, Curb JD. Cholesterol and all-cause mortality in elderly people from the Honolulu Heart Program: a cohort study. Lancet. 2001 Aug 4;358(9279):351-5.
(vii) Hansson GK Inflammation, Atherosclerosis, and Coronary Artery Disease N Engl J Med 352:1685, April 21, 2005
Dear Dr. Hyman,
Thank you for an excellent overview of cholesterol-related matters. Perhaps you know about the reduction in Homocysteine, inflammation, and improved endothelial function associated with Juice Plus? I would love your review on these studies, available on my site. Our Professional Support Program helps busy MDs who want to take and recommend our program to patients and colleagues.
Best wishes,
Amy Shapiro
You’re terrific! Thanks for your good work… May I interview you for an article I’m writing?
Due to the level of queries Dr. Hyman cannot respond to questions of this nature at this time. Thank you for your interest in Dr. Hyman’s work.
Having read your info. re: IBS, I followed the protocol you suggested. I had Hpylori in my stomach and just had the breath test. Now with eating yogurt everyday, I no longer suffer from IBS. i had the condition for over 40 years and am now IBS free with minimal flare ups only when I do not eat correctly.
Now my physician has recommended Lipitor. No way am I taking this drug. I am about to change the yogurt to low fat and eliminate butter from my diet and also since I love carbs (white ones at that!!!) I am now going to eliminate white carbs from my diet. I already use olive oil and never ate red meat. However, I do have a
“sweet tooth” and for the most part use Stevia (pure) for tea etc. I am now about to introduce Green Tea and B6 and B12. I already take Pacific Salmon oil capsules. Thanks for your website and your email newsletters.
“
I am so glad I read the previous article on cholesterol lowering and statins.
I have repeatedly been told I must take statins because of high cholesteral–high of 300—hdl of 54—-
The statins ( I have so far been on 4 different ones) are producing some very
uncomfortable side effects—Crestor caused muscle break down, zetia and crestor caused muscle,joint pain,dizziness etc. I am currently (until today) taking Lipitor which is causing shortness of breath, joint and tendon issues, and sinus pressure, headache and runny nose. I have decided to stop to stop taking any statins and take my chances. I would apprreciate any feedback you might be able to give me
Dear Dr Hyman,
I am very inspired by reading your health information. I’m a retired MD from Sweden, and have for the most part of my life been living a healthy life style with the food choices that you are suggesting – partly because of food allergies, mainly delayed, causing fatigue and constipation, but also because I do believe that life style and food choices really make a difference in health.
It has recently been discovered to my surprise that my A1c levels are high (6%) and fasting blood sugar 90 mg/dl even though I hardly have any sugar in my diet. My Triglycerides are 55 and HDL 107 but with LDL 148 my doctor is still not satisfied. The ratio CHOL/HDL is 2.5 and TRI/HDL is 0.5. 85 % of my LDL seem to be the fluffy kind, size I and IIab. However my fibrinogen is high 490 and Extended Lp(a) is also high 86.
I feel confident after reading your article that my cholesterol is not a problem, but I am not sure what to think about the fibrinogen.
I’d guess that the inflammation level in my body is still high, probably because of my food allergies. I’ll have them tested again, and I am starting a more rigorous exercise program. I have been taking supplements for many years and I will add a couple more according to your suggestions in the Diabesity Prescription.
Thank you for bringing clarity to the world about these common health issues!
Karin Granstrom, MD
What can be done to reduce CRP levels?
homocysteine levels “… appears to correlate to cardiovascular events”? SEARCH trial (JAMA2010) showed that reducing homocysteine levels with B9,B6,B12 did not reduce cardiovascular events.
Dear Dr. Hyman:
I am 85 years old and seemingly in fair health with no known heart problems. A lipid blood test completed on 11/1/2010 showed an HDL reading of 34, with LDL at 122. Overall total is 183.
My doctor will not prescribe any medication until he examines me in 1/2011 since he says there are no studies indicating the efficacy of statins or niacin to correct cholesterol in a person in his eighties. I am very concerned about getting a heart attack or stroke since these readings would seem to indicate I am at great risk.
Frankly, I have not been getting the best medical attendance. Can you help and give me some advice as to whether statins and/or niacin may be in order for me. Thanks very much. Jim Mavridis 12/15/10
My doctor is suggesting a statin.
My Cholesterol/HDL ratio is 3.2
I have read your book “ultrametabolism” and this article.
I don’t think I should take a statin.
Do you agree?
thank you for your views on cholesterol. Two yrs ago I was put on chol. meds – Zetia for high chol. 228. After a year with little improvement I started with horrific side effects, extreme painful full body cramps, light headness, & final straw, nose bleeds. All side effects of Zetia. I stopped taking it immediately. Dr. changed meds to TriCor. After 6 months or so with little improvement (196), meds were changed to Trilipix. Also, at this time Dr. retired & changed cardiologist who kept me on Trilipix. I saw my Dr recently & told him I stopped Trilipix because I started with same side effects as Zetia. He said he could change my meds to another simvastatin but felt I would have the same side effects. He wants me to follow a low chol. diet & if in 3 months I have not shown improvements he will try the simvastin. I know sugar drives this & I love sugar, but not anymore! So it’s out & exercise & revised diet plan is in. This should also help with depression too. Am looking forward to the New Year with new & improved health benefits thanks to your website & my determination.
Extraordinary this submit is totaly unrelated to what I was looking google for, nevertheless it used to be listed on the first page. I suppose your doing one thing proper if Google likes you sufficient to position you on the first web page of a non related search.
You say that statins are good for people like me who have already had heart attacks. I have wondered about that. Can you point to research for that conclusion? I have become well-versed with the risks of taking statins, but none the popular literature differentiates according to heart histories. Thank you.
Thank you for offering me so useful info.
sir, i just had liposcience lab work. and the results are as follows: ldl-p 1643 ldl
particle #.
ldl-c lipids mg/dl 138 hdl-c mg/dl 45
particle concentration and size as follows: hdl-p total 28.9
small ldl-p 663
ldl size 20.7
large vldl-p 0.7, small ldl-p 663, large hdl 4.6, vldl size 40.5,
ldl size 20.7, hdl size 8.7 . lp-ir score 38
suggestions requested, thank you
Thanks for the great explanation. I’m working with a nutritionist who informed me that my cholesterol was too low. I couldn’t believe such a thing was true. You confirmed what she was telling me through this excellent article.
Dr. Hyman
No matter if you don´t answer the message, I just want you to know this.
God bless you!!!
Great info here! I am a 57 yr old female with parkinson’s disease. Recently the muscles in my left hip got so painful I had to walk with a cane. I was hobbling around like I was 80 and in a lot of pain. My masseur said he had had several clients who had this type of pain and found it to be statin cholesteral meds. He mentioned one lady had permanent leg muscle damage. I stopped taking them and viola, I not longer have hip pain and walking cane free. I also had some real dry facial patches that were troublesome and now they’re completely gone.
My cholesterol is sky high around 500 when im off my medication around 300 when im on it.
The Dr. Tells me it probably runs high in my family, but we really dont have a history of heart disese in my family.
The Dr. says diet and excersise isnt enough that I need to be on a staton drug.
Any recomendations would be appreciated .
Thanks Larry
Thank you, Nancy, for your message and your interest in Dr. Hyman’s work. Your question and constellation of symptoms represents a complex medical condition. Questions regarding conditions like these cannot be answered in a responsible manner via the Internet.
If you would like information on becoming a patient at The UltraWellness Center please see “How to Become a Patient” at http://www.ultrawellnesscenter.com. That site is designed to give prospective patients a comprehensive source of information about The UltraWellness Center. You may also feel free to call The UltraWellness Center at (413) 637 9991.
Regardless of becoming a patient at The UltraWellness Center, it sounds like you need to consult with a doctor. Please seek medical attention for the issues that you outlined in your message.
Wishing You the Best of Health!
Thank you, Goldie, for your message and your interest in Dr. Hyman’s work. Questions regarding conditions like these cannot be answered in a responsible manner via the Internet.
If you would like information on becoming a patient at The UltraWellness Center please see “How to Become a Patient” at http://www.ultrawellnesscenter.com. That site is designed to give prospective patients a comprehensive source of information about The UltraWellness Center. You may also feel free to call The UltraWellness Center at (413) 637 9991.
Regardless of becoming a patient at The UltraWellness Center, it sounds like you need to consult with a doctor. Please seek medical attention for the issues that you outlined in your message.
Wishing You the Best of Health!
Thank you, Jim, for your message and your interest in Dr. Hyman’s work. Your question and constellation of symptoms represents a complex medical condition. Questions regarding conditions like these cannot be answered in a responsible manner via the Internet.
If you would like information on becoming a patient at The UltraWellness Center please see “How to Become a Patient” at http://www.ultrawellnesscenter.com. That site is designed to give prospective patients a comprehensive source of information about The UltraWellness Center. You may also feel free to call The UltraWellness Center at (413) 637 9991.
Regardless of becoming a patient at The UltraWellness Center, it sounds like you need to consult with a doctor. Please seek medical attention for the issues that you outlined in your message.
Wishing You the Best of Health!
Thank you, Diana, for your message and your interest in Dr. Hyman’s work. Your question and constellation of symptoms represents a complex medical condition. Questions regarding conditions like these cannot be answered in a responsible manner via the Internet.
If you would like information on becoming a patient at The UltraWellness Center please see “How to Become a Patient” at http://www.ultrawellnesscenter.com. That site is designed to give prospective patients a comprehensive source of information about The UltraWellness Center. You may also feel free to call The UltraWellness Center at (413) 637 9991.
Regardless of becoming a patient at The UltraWellness Center, it sounds like you need to consult with a doctor. Please seek medical attention for the issues that you outlined in your message.
Wishing You the Best of Health!
Thank you, Jim, for your message and interest in Dr. Hyman’s work. Your question and constellation of symptoms represents a complex medical condition. Questions regarding conditions like these cannot be answered in a responsible manner via the Internet.
If you would like information on becoming a patient at The UltraWellness Center please see “How to Become a Patient” at http://www.ultrawellnesscenter.com. That site is designed to give prospective patients a comprehensive source of information about The UltraWellness Center. You may also feel free to call The UltraWellness Center at (413) 637 9991.
Regardless of becoming a patient at The UltraWellness Center, it sounds like you need to consult with a doctor. Please seek medical attention for the issues that you outlined in your message.
Wishing You the Best of Health!
Thank you, Ken, for your message and your interest in Dr. Hyman’s work. Your question and constellation of symptoms represents a complex medical condition. Questions regarding conditions like these cannot be answered in a responsible manner via the Internet.
If you would like information on becoming a patient at The UltraWellness Center please see “How to Become a Patient” at http://www.ultrawellnesscenter.com. That site is designed to give prospective patients a comprehensive source of information about The UltraWellness Center. You may also feel free to call The UltraWellness Center at (413) 637 9991.
Regardless of becoming a patient at The UltraWellness Center, it sounds like you need to consult with a doctor. Please seek medical attention for the issues that you outlined in your message.
Wishing You the Best of Health!
Thank you, Larry, for your message and your interest in Dr. Hyman’s work. Your question and constellation of symptoms represents a complex medical condition. Questions regarding conditions like these cannot be answered in a responsible manner via the Internet.
If you would like information on becoming a patient at The UltraWellness Center please see “How to Become a Patient” at http://www.ultrawellnesscenter.com. That site is designed to give prospective patients a comprehensive source of information about The UltraWellness Center. You may also feel free to call The UltraWellness Center at (413) 637 9991.
Regardless of becoming a patient at The UltraWellness Center, it sounds like you need to consult with a doctor. Please seek medical attention for the issues that you outlined in your message.
Wishing You the Best of Health!
Dear Dr. Hyman. I’ve been reading all of your articles on cholesterol on both your site and The Daniel Plan site. Yes, some of this does come as a surprise, but is welcome information. I’ve just had a doctor tell me I MUST go on a statin to lower my LDL and I’m fighting it. I’m mid-fiftes, thin, strong, healthy and eat healthy. HDL is great at 85, Tri’s are low at 63, LDL is the problem at 127. Doctor tells me it is genetic and nothing I can do except meds. I’ve not yet tackled all of the other tests you list. I’m concerned about what to do next.
I had a MI in 08/2009. My stats were as follows:
total chol 115
LDL 74
HDL 16 (I know)
Trigs 126
I was 34, 5’9 155, exercised frequently, and “ate healthy”. Its in ” ” because I ate a very high carb, low fat diet.
My cardiologist eventually got me to statins. I’m now doing high fat, low carb (paleo). Hope to get my HDL up and my trigs down. Here’s my lipid panel from a few weeks ago:
total chol 159
LDL 98
HDL 34
Trigs 135
Is the statin helping or hurting these #’s?
Hi Chris, thank yoou for your interest in Dr. Hyman’s work and for your message. We can’t offer you medical advice over the Internet but if you would like an evaluation by Dr. Hyman you are welcome to contact the UltraWellness Center at (413) 637 9991.
Wishing You the Best of Health!
Dear Dr Hyman. Thank you for the vast amount of medical information you provide to the lay reader and professionals as well. I am 62 years old and practice conventiional periodontics in private practice. I became interested in your work when I started to have significant problems with premetabolic syndrome, high CRP, loss of memory brain fog, and fatigue. A year or so ago, the periodontal community and cardiologists collaborated and began a focus on the inflammatory portion of most periodontal conditions. When the Jupitor study was released, it was proposed that rouvastatin would be benificial in general for bringing down inflammation measured as CRP.
As a large number of conventional medical practioners have little interest in patients’ mouths and most dentists are looking at teeth, I feel it is necessary for the periodontists to develop protocols for treating periodontitis as a full body inflammatory condition. Through this new mindset, I am seeing baby boomers and their parents daily who are suffering from autoimmune and nutitional deficient signs of chronic lack of medical attention or medical integration of disease. As I travel through understanding functional medicine for myself, I struggle with how I can most effectively help my patients-lab tests, dietary supplements, reduction of mouth drying tooth decaying conventional medications. I need to develop a protocol for testing and treating my periodontal patients which will be cost effective for this age set and give them real value. No one argues our looking at diabetes and now Vit D. levels. It would be really beneficial if you could outline other key diagnotics we can order which are both appropriate for our scope of practice and divide patients who need a complete functional medicine work up from those who we can treat along with conventional dental therapies. Everyone I see these days has IBS, Gerd, hypertension, high cholesterol, probably metabolic syndrome. Where does one start without overstepping boundaries and medical training? Christine Ford DDS
Mark-
At what point are you going to inform your readers that at the base of ALL Cardiac Disease & ALL risk factors is Magnesium defiency & a dysfunctional Ca/Mg ratio?
It’s time the public understand the magnitude of deception that the Food, Drug & Medical Industries have exacted, all in an effort to cover up this foundational & life-enhancing fact.
Here’s what adequate Mg levels do:
Control Amount of Cholesterol being produced
Conversion of LDL to HDL
Degree of Endothelial inflammation
Controls levels of C-reactive protein
Controls levels of Homocysteine
Controls the ability of Insulin to do it’s job
Should I continue?!?
I would encourage you & your readers to read articles by Lawrence Resnick, MD & start bulking up on your Mg levels in this Cholesterol-phobic & Calcium-crazed society we Re now a part of.
My wife had severe muscular reactions to Crestor before they came out with the disclaimer on the ads to the point where she couldn’t lift herself out of bed. It was only after I found some horror stories on the web and took her off of it that she improved, and I didn’t wait for her doctor’s approval, although she still has some pain in her legs. I’m amazed the FDA approves these drugs when they have such dibilitating side effects for so many people but I guess it’s money talks you-know-what walks.
Before my mother passed away she suffered from Alzheimers and she loved sweets but it wasn’t until high fructose corn syrup was approved and started showing up in everything, I believe it was the eighties, that the disease became so prevelant. I’m firmly convinced there is a correlation between the proliferation of HFCS and not only the epidemic of diabetes in America but also the explosion in Alzheimers and in the future I believe there will be massive class action lawsuits against the manufacturers much like the cigarette cases(No pun intended.).
Thanks for the great article. I have high cholesterol, but I’m a thin, healthy 55-yo male. No indication of CVD and I feel fine. I’ve been fighting my doctors for 11 years; they want me on statins but statins make me feel horrible -like unending flu. So now I won’t take them -none of them, and I’ve felt justified by articles like yours. Now, I’m confronted with LDL-P data which is really bad, and once again I’m told I should be on a statin. But I won’t do it -because life on statins is not worth living -at least for me. I think they are toxins. I’ve found that my LDL is greatly impacted by carb consumption, so I’ll try to cut back on carbs -but I do love them, hate to give them up. Also taking Welchol, which I tolerate well.
I’ve found that statin skeptics and cholesterol skeptics don’t have much to say about LDL-P, and that’s frustrating. If LDL-P is what really matters, the skeptics need to address it!
When it was discovered that I had heart valve problems in 2007, and needed surgery, I was put on Crestor ( 5 mg ) by my new cardiologist. My lifelong MD never put me on statins because he felt my ratio was adequate ( LDL 162 HDL 92 ). My life was active, I weight trained daily, ran, and had 3 horses in heavy training. I worked as a Dental Hygienist and needed the physical training to keep my back in shape. I was 57, weighed 142 and was 5’6″. My diet was good, with few red meats, many vegetables and minimal carbohydrates. I was lactose intolerant, so dairy was very rare. Prior to surgery, I had a cardiac Cath which showed no arterial blockages, neither did carotid Dopplers. But because I was a “heart” patient, my new cardiologist insisted on Crestor one month before valve repair surgery. Long story short: Crestor caused my platelet function to decrease and surgery had to be posponed for a week. During surgery, my bleeding ( after never having had a problem before ) was uncontrolled necessitating numerous units of blood ( statins block the formation of thromboxane in the mavalonate pathway ). After surgery, despite my “exceptional physical condition”, I could not recover. I had intense muscle pain that continued to get worse. I had intense anxiety, limb numbness, sleeplessness, transient pain and paralysis. There were times I could not move my arms and had trouble expanding my chest to breathe. The surgeon felt I should have recovered from the minimally invasive surgery within weeks. The cardiologist immediately said “Its NOT THE STATINS!!!” Well, 8 months after starting the statins, I went to the ER with chest pain, transient paralysis, fatigue, screaming muscle pain and brown urine. I stopped the Crestor on my own a few days before my hospital stay – during which, every test in the book was done on me. I got steadily better by leaps and bounds over the week in the hospitol while off Crestor. I KNEW it was the Crestor. I changed cardiologists, and the new Dr. immediately identified the problem from my records as rhabdomyolysis caused by the Crestor. He suggested taking niacin….I had taken it many years before with no problems. Two weeks after starting it, the symptoms that the Crestor had caused began again. Tried red rice yeast….same thing. After the Crestor, I can’t take anything that affects cholesterol. Also, over the 8 months I was on Crestor, my LDL rose sharply, my HDL dropped sharply, and my triglicerides rose. Crestor destroyed my life. Doctors will tell you that if you are a sensitive person, once you stop your statin, all symptoms subside. NO!! They don’t. I am now, exercise intolerant. MY legs are well and I can walk on the treadmill, but my whole upper body lost all muscle tone and bulk. I can barely work with my horses anymore, have no strength in my upper body, and when I try to work my upper body muscles ( where all the surgical incisions took place ) I trigger an intense exercise intolerance reaction. Crestor destroyed my life. I would say to anyone experiencing muscle and joint pain and fatigue…pins and needles….numbness in fingers or toes, anxiety and emotional stress or anger while on statins, to take a month off. Tell your doctor you want to try a “time out” on your statin. If the statin is causing you problems, you will know fairly quickly.
For a 30 year old woman with high cholesterol whose only risk factor is PCOS (polycystic ovarian syndrome), should I be concerned with these cholesterol results:
My results: Standard range:
CHOLESTEROL (LAB) 246 < 200 mg/dL
TRIGLYCERIDES 105 40 mg/dL
LDL CHOLESTEROL, CALCULATED 156 < 100 mg/dL
VLDL CHOLESTEROL, CALCULATED 21 < 31 mg/dL
NON-HDL CHOLESTEROL 177 < 130 mg/dL
HEMOGLOBIN A1C 5.1 < 5.7 %
Neither of my biological parents have heart disease and my blood pressure runs between 105-115/60s, HR 60-70s. I am 5'5" and weigh 135-140 pounds. As you can see my A1C is normal. I have requested a CRP test based on your article.
Thank you for your time.
Hello and thank you for your post. We cannot advise you over the internet as to the test results you have mentioned. Please work with a physician to manage your care.
Wishing You the Best of Health!
My cholesterol was around 155/60 (LDL/HDL) for fifteen years, but at age 44, I received a calcium score of 42 – high for my age. I radically changed my diet and began taking fish oil. For the past two years, my diet has been: lots of vegetables, lean protein, fish, nuts, low fat dairy, and some whole grains. I’ve always done 30 minutes of cardio three times a week, and I’ve continued that. My cholesterol is now 111/79 (triglycerides have always been around 60), my CRP dropped from 3.7 to .3, and my fasting glucose has dropped from 98 to 92.
I lowered my heart disease risk dramatically, without drugs, using a simple program of diet and exercise.
re: Sally’s comment. I would direct her to the part of the article that says:
“… total cholesterol is not as critical as the following:
Your levels of HDL “good” cholesterol vs. LDL “bad” cholesterol
Your triglyceride levels
Your ratio of triglycerides to HDL
Your ratio of total cholesterol to HDL”
Good for you Kurt!
You have presented information I’ve been looking for. Thank you.
I had a physical a year ago and was advised by my doctor to consider statins to reduce cholesterol. I refused at that time, but want to make informed choices. Here are my basic stats:
55 years old, 5’11 195 lbs. Blood pressure was said to be exceptional, cardiogram also exceptional. Cholesterol was 129 with 65 LDL and 64 HDL. I don’t smoke, work out 4-5 days a week including cardio and resistance training. I eat a careful diet, very rarely sick in any way. My family does have a history of high cholesterol and stroke-like events after age 75 (though life style was not particularly sensitive to these issues including smoking). I feel good, am outstandingly fit though obese by the charts – how silly these are, I’m active, practice yoga though do have a high stress job. I guess I’d really like a doctor who looked at me, not the just the charts and stats.
My total cholesterol is 210, triglycerides 52, HDL 56, LDL 143.6,
ratio LDL/HDL 2.6, glucose 103. I am 49 yrs old. My diet does not include
refined carbs and eat 4-5 cups of vegetables daily with approx 70 oz of protein
per day and 30-40 grams of carbs per day including the vegetables. This has
resulted in most of my numbers being good but would more excersice lower my
high LDL number?
I am a 69 year old female.I recently had my cholosterol checked ,my results were
HDL – 299
LDL -213
My doctor suggested taking 20mgs of Lipitor I do not want to take. Would I be safe in just taking omega-3, magnesium and calcium.? As well as changing my diet and exercise. I too experienced taking lipitor a couple of years ago and it reduced the levels but I had muscle cramps and it made me agitated so I stopped it
I need advice
Hi Bobbie,
Thank you for your interest in dr. Hyman’s work and for sharing your story with cholesterol. Have you looked at where excess sugar or refined carbohydrates are in your diet? Have you considered the quality of fat in your diet? These are some excellent questions to ask! We want to maintain strong levels of omega 3 fats as well as monounsaturated fats and somei natke of saturated fat, especially from coconut oil. If you would like to know more about your personal levels, check this out: http://store.drhyman.com/Store/Show/Home-Testing/814/Omega-Quant-HS-Omega-3-Index-Test
In order to provide you the proper care you need re: medications, we hope you will seek the attention of a local qualified Functional Med practitioner soon. To locate a doctor who practices functional medicine like Dr. Hyman, go to http://www.functionalmedicine.org/findfmphysician/index.asp and scroll down to where it says “locate a practitioner” and enter your zip. Progress accordingly from there.
In good health
Lizzy
I wish I read about this before my poor dad went on statins. He’s a pretty healthy guy, walks every day, but does carry some weight around his middle. His doctor put him on statins for a poor HDL:LDL ratio, and now my dad limps a year after going off the drug from the muscle damage it caused. My dad’s favorite thing to do is go for walks with the dog and take pictures of flowers, and now he’s in pain. It absolutely breaks my heart. He was trying to do the right thing by listening to his doctors, and now he is worse off than before. Thank you for educating people, and for being rightly skeptical of big pharma’s claims.
I was given Lipitor in the early 2000′s although my cholesterol overall was only 217. Within two weeks time I was so weak I couldn’t get out of bed. I quit taking it and my doctor never would acknowledge that the Lipitor was the problem. But after about a month I was feeling better since I quit taking it. Then in 2010 he put me on Welchol saying it would probably suit me better. After taking it for about 6 months I started having this electrical shock feeling in my stomach area when I reached for something or moved a certain way. Then came the pain in my stomach which was miserable. I couldn’t even tightened my belt my abdomen was so sore. I quit taking the Welchol and the stomach pain has lessened over the last 6 months but I still feel the electrical shock feeling but not as much. My doctor never suggested what causes this feeling and seemed unconcerned. I will never take another cholesterol medicine again. NEVER!!!! It seems in the case of cholesterol problems the “cure” is more dangerous than the problem.
Dear Dr. Hyman,
My high-sensitiviey CRP is under 1; my HDL is 79; my trigylcerides 83. So, even though my LDL and total are high, I ignore the advice of my well-meaning PCP. My ratio only started inproving since I began ingesting organic, cold-pressed coconut oil on a daily basis. Now, every three months, when tested my HDL continues to climb, resulting is an ongoing better ratio. My mother died from a stroke when she was in her early 30′s, so I am considered at high risk. However, I am very careful to live a healthy lifestyle avoiding all the known risk factors relating to a poor diet, lack of exercise, poor sleep, etc. I do not make my doctors responsible for my health. I am…
For those of us conditioned to a low fat, low cholesterol seeking diet, giving up the statins is scary. I don’t live near a functional medicine practitioner. How can some one like me get the requisite testing (as described in this article) done? I doubt that my doctor will read this article or order the tests! Without a willing and enlightened physician, us patients seem at the mercy of big Pharma and “the system”. We called your center, and learned that unless we were independently wealthy we could not afford your services, and you offer no “sliding scale”. Any suggestions?
Hi Douglas,
Thank you for writing in. We are glad to help in any way we can. A great idea is to ask your doc to order an NMR test and a Hemoglobin A1c through a conventional lab like LabCorp or Quest. You can also do a glucose tolerance test through these companies too!
To locate a doctor who practices functional medicine like Dr. Hyman, go to http://www.functionalmedicine.org/findfmphysician/index.asp and scroll down to where it says “locate a practitioner” and enter your zip. Progress accordingly from there.
And if what you need is some simple coaching and questions answered it is our pleasure to offer you nutrition coaching: http://store.drhyman.com/Store/List/Coaching-Programs
In good health!
Lizzy
I am approaching 60 and out of a want to have a baseline & not for having any slight CAD symptom or attack ever that I did a CAT scan just to be surprised to find a 60% blockage on the upper side of my LAD Coronary Artery about 6 months ago & further substantiated by a Nucleus. For the past 5+ years, I have had very good and below hurdle Lipid Profile figures, weight, blood psi and no other illness although lacking routine exercise. I commit myself to a total lifestyle and diet change although my Cardio prescribed exercise and 20 mg Lovastatin as a ‘measure’ to reduce chance of rupture but the Rx cranked my LDL from 83 to an absurd 54, HDL is 42, TC from 130 to 100 but I always have an urge to get off that to ‘save’ my liver. My ambition is to not let the blockage grow and prevent rupture with no dream that I can reverse the block.
My key question is to get a correct perspective when I try to apply what I read from your several articles now that I have one 60% blockage, therefore technically I have CAD knowingly. I guess your articles are written mostly from the perspective of assumed healthy person and things he/she should do. In my situation, can I apply these knowledge at my discretion of course with the same level of confidence as a non-CAD person or I should be more conservative?
I read with a feeling of great discovery of knowledge regarding plaque and CAD and unfortunately your site did not pop up in Googling months ago at which time I first came across the concept that cholesterol alone without inflammation will not likely form plaque and blockage. That was an eye opener already. I also started to dig into Ornish’s and Esselstyn’s books; and have gone into very very plant based diet, restricting heavily on saturated fat, pump up Omega 3 with Flax. I am basically do a majority of things you talk about but the precaution against sugar was only limited to prevent spikes. Armed with the new knowledge, I will do more to crank down my pre-diabetic conditions then.
Additional question: I have never been able to get to a 60 HDL level during all these years. It was like 45 pre-plant based diet and it actually dropped once I am on a plant based diet. What else can help? Exercise did not add much. I do not want to be on Niacin, to preserve my liver because I expect that a h uge dosage is needed to raise the HDL by a few points only.
I liked the beginning of the article when you used scientific studies to discuss
cholesterol. Then you started talking about “sugar”. I could not find the studies
showing that eating sugar causes heart disease. Please let me in on this research.