Cholesterol & Statin DrugsNovember 2004
By William Davis, MD, FACC
|LE Magazine November 2004|
|Cholesterol & Statin Drugs|
Separating Hype from Reality
By William Davis, MD, FACC
What the Doctor Does Not Tell You
Let’s dispel some popular statin and cholesterol myths:
What qualifies as low HDL? National guidelines say it is a level of less than 40 mg/dL for men and less than 45 mg/dL for women.50 In fact, a level of less than 60 mg/dL is probably very significant.51 HDL is already a standard measure in everyday cholesterol panels. Small LDL particles, on the other hand, need to be measured specifically. The medical world focuses on statin therapy for LDL, while the most prevalent risk factor for heart disease goes untreated in the great majority of cases.
Giving the Paradigm Shift a Shove
Let us discuss the most prevalent risk factor for heart disease: low HDL and small LDL particles. Testing for HDL is included in any standard lipid (or cholesterol) panel, along with testing for LDL, total cholesterol, and triglycerides. Small LDL particles, on the other hand, need to be specifically measured.
Generally, the lower your HDL level is below 60 mg/dL, the more likely you are to also have small LDL particles, and the greater your risk for hidden coronary disease. Both abnormalities are also strongly associated with insulin resistance (i.e., an inability to respond to your own insulin) and risk for diabetes. Low HDL and small LDL particles respond to the same treatments and lifestyle changes, and the risks associated with each are hugely magnified by excess weight. With 47 million adults with metabolic syndrome in the US today, low HDL and small LDL are epidemic.
Weight loss (if you are overweight) is the most powerful and healthy way to correct the entire picture. Losing even the first 10 pounds of excess weight can raise HDL, suppress the small LDL pattern, and enhance insulin response. Some people will, however, require dramatic weight loss before full correction is seen, depending on genetic factors and their amount of excess weight. Carbohydrate restriction (eliminating or minimizing flour products such as pasta, bread, cookies, cakes, and other processed foods) is an effective way to lose some weight when you have these patterns.
Among supplements, white bean extract is a great way to accelerate weight loss if you have the low HDL and small LDL pattern. White bean extract blocks intestinal carbohydrate absorption by 66% with minimal side effects, unlike its prescription counterpart (which causes abundant gas).55,56 Taking 1000 mg twice a day with meals can lead to 3-7 pounds lost in the first month.
Calcium pyruvate (2500 mg twice a day) is another weight-loss accelerator that is safe and free of ephedra. Calcium pyruvate has a two-pronged benefit. First, it accelerates weight loss (by a poorly understood mechanism), usually resulting in a few extra pounds of weight loss over several weeks. Second, it also has the interesting property of enhancing exercise by making it easier and less taxing, thus enabling you to exercise longer and harder with easier recovery. Exercise “highs” are achieved more easily with calcium pyruvate supplementation.57
Supplementing with niacin (vitamin B3) is a direct, effective way to raise HDL and lower small LDL. Doses of up to 500 mg daily can be taken safely; higher doses of 1000 mg or more should be taken under medical supervision, as these occasionally result in liver dysfunction, elevation of blood sugar, stomach intolerance, and gout. Niacin typically causes a hot flush (usually of the chest, neck, and face) that is harmless though annoying. The flush usually can be inhibited by drinking plenty of water, taking niacin with solid food, and avoiding spices and alcohol when you take the tablet.58,59 Always take folic acid and vitamin B12 with niacin to protect against disruption of healthy methylation patterns. Folic acid and vitamin B12 also help to lower homocysteine, another important piece of the atherosclerosis puzzle.
Fish oil can also raise HDL and lower small LDL when taken in the form of a concentrated omega-3 preparation that provides at least 1400 mg of EPA and 900 mg of DHA per day. Fish oil has tremendous benefits beyond its lipid effects, including reduced mortality from heart attack, anti-inflammatory and mood-improving effects, and reduced cancer risk.60,61