Doctor Wants Her On Statins

Email from a reader a few weeks back:

Hi Dana,
Gosh, love that email address.. :)
I have been talking back and forth with Ann Canlin about cholesterol recently because I just had my physical and even though I always ran a little high with total and LDL, my HDL and trig. were always very good and the ration was usually around 2.8

I started this diet (Jorge Cruise) not exactly to the letter but mostly low carb (which I have done before) but eating more eggs and cheese than I would do before because of my cholesterol. I was hoping I would be one of the many people on his blog that kept reporting that eggs and fat really did not affect their cholesterol. Unfortunately, yes it did big time. I had my yearly blood test and this time the cholesterol total was up 30 pts. (283) The LDL which was 151 (slowly creeping up every year) is now 182. My HDL which was 76 last year is now 91 and my trig. which were 86 are now 51... ratio 3.1

My doctor commented to start exercising more, eat low fat diet and see her in three months to repeat.. if LDL not down she wants to put me on a statin... NO WAY !!!

Now granted, I am 57 and the same thing happened to my Mom when she got older her cholesterol went up, my Dad had high cholesterol, my Grandfather died at 71 of arteriolosclerosis and my Mom's Dad died when she was 16 of heart disease so I do not want to play around but I do want to get this LDL down more...and the total number.

I cannot eat eggs obviously, or bacon, ham, etc. etc. and I am giving up the cheese.. :(
I cook with virgin olive oil, I eat nuts, I take krill oil, B12 and have limited my carbs and have lost 8 lbs. since March. I do not follow the diet (Jorge Cruise) exactly, just use some of his ideas for meals and I am still trying to figure out that carb swap thing but its a little complicated???

My doctor is very nice, but she sees me as a worrier (which I am) but I have had several joint replacement operations and I do question everything which I know doctors don't like. I sent her some information that Ann sent about formulating my numbers and her response was "too many questions, just follow what I said and see me in three months.." That an HMO for you. I can switch but it would be a hit and miss to start over and start to find someone else as a GP but I may have to do it in the future.. I am relatively healthy, no high BP, no sugar problems, Just high Cholesterol.. Any thoughts on any of this? I would appreciate it. I will see her in a few months, I would like to arm myself with something that is proven and written to show her that would be difficult to dispute.. ?

P.S. Mom (78) is on Lipitor, so is my hubby... for several years, but his HDL was very low...and the other numbers high.. now his total is 151, HDL 60 so its working for him but I do not want to have to go that route if necessary..
Thanks,
Stacy

DISCLAIMER: I AM NOT A DOCTOR. I DO NOT PLAY A DOCTOR ON TELEVISION. I HAVE NO MEDICAL DEGREE OF ANY KIND. I JUST READ A LOT. TAKE THIS FOR WHAT IT IS WORTH.

Hey, Stacy --

First of all, I confess to not having read The Belly Fat Cure; it's on my list, but as of now I don't know about carb swaps.

Secondly, if it's tough to change doctors, I'd get up in this one's face: "What do you mean, too many questions? This is my body, you're supposed to be helping me care for it, and I'll ask as many questions as I need to to understand what's best for me to do. It's your job to answer them." I would also tell her that since your ratios are actually better, you're not going to be panicked into taking a drug that has potentially nasty side effects without exploring all the other options.

Third (oh, gosh, I have to count everything off now, don't I? See where these things get you?), lowering your triglycerides will artificially raise your LDL. Why? Here's a copy and paste from an article I wrote a while back:

If, as is the case with so many low carbers, your triglycerides are on the floor -- I've seen mine as low as 36 -- be aware that this will artificially skew your LDL number higher. Why? Because LDL is rarely measured directly, but rather is calculated using something called the Friedewald Equation. The equation goes like this: LDL = TC - (HDL + T/5). In English, that says "LDL cholesterol equals total cholesterol minus HDL plus one-fifth of your triglycerides." Apparently this equation is fairly accurate if your triglycerides are between 100-200.

But when your triglycerides drop really, really low -- a good thing -- that one-fifth of triglycerides drops, too, and there's far less to subtract from the total cholesterol number, skewing the LDL higher. Doctors know this, but seldom think of it when looking at LDL numbers that are running above what they've been trained to look for. My LDL was just a touch "high" at one point; I pointed out my super-low trigs to my doctor and said, "I could lower my LDL by raising my triglycerides." She laughed and said "Bad idea." Yet when my next blood work was done, she commented favorably on my LDL having dropped into the "normal" range -- until I pointed out that, sure enough, my trigs had gone up all the way into the 70s.

Just keep the Friedewald equation in mind, okay?

Indeed, Stacy, I'd point this fact out to your doctor. If she doesn't know that super-low triglycerides result in an artificial rise in LDL, shame on her.

In the discussion following my blog post that talked about the Friedewald equation, a reader posted a revised equation for estimating LDL among people with very low triglycerides; it's from this med journal article. The revised equation is:LDL = TC/1.19 + TG/1.9 - HDL/1.1 - 38 . I ran this equation using your numbers, and came up with a revised LDL of 143. Still in what's considered the "borderline" category, but combined with your trigs and HDL it sounds not-terribly-scary to me.

You could also ask for (heck, demand) some other tests:

* Tests to determine what percentage of your LDL is of the large, fluffy variety versus how much is the small, dense LDL. Turns out that large, fluffy LDL isn't a risk factor for heart disease, only small, dense LDL is. (And read my article on what a "risk factor" means!)

* A test of your Lp(a). Lp(A) is another sub-fraction of your LDL that is a better predictor of heart disease risk -- ie, more closely correlated with it -- than just your LDL number.

* A calcium score, to see if you actually have any plaques in your arteries. Keep in mind that a calcium score uses a CT machine, which exposes you to considerably more radiation than a regular x-ray.

There are also things you can do to lower your cholesterol without drugs. Though I'm unconvinced of the value of lowering cholesterol in and of itself, these things are harmless, cheap, and have their own benefits:

* Add soluble fiber. Soluble fiber is the reason why oatmeal has a reputation for lowering cholesterol. Here's the deal: Soluble fiber in your gut binds with the digestive fluid bile. The bile that has been bound up is then passed out of the body in your feces, requiring your body to make more. Since cholesterol is one of the components of bile, this requires your body to use up some cholesterol, lowering levels a tad.

You know I'm not going to recommend oatmeal, right? But there are plenty of other sources of soluble fiber. The easiest is probably sugar-free Metamucil; just chug a glass a day. Or you can buy just straight psyllium hulls -- the fiber in Metamucil -- at your local health food store, and take them. Grapefruit or other citrus pectin is also supposed to be effective for this purpose; again, this is available at health food stores. You could take extra guar, xanthan or glucomannan; they're all soluble fibers. Flax seed meal is a good source, as are chia seeds; you could cook with these or just swallow a couple of spoonfuls a day.

* Add niacin, aka B3. Niacin lowers total cholesterol and raises HDL. It's cheap. It's safe. (Indeed, I've been meaning to write an article about recent tests on niacin.) Here's the thing, though: It'll turn you red and itchy for about 10 minutes. This is called the "niacin flush," and it's caused by a histamine release. Back when I was in the health food biz, I used to have people return niacin because they were sure they were deadly allergic. They were not; it was a normal reaction, to be expected.

There is "flush-free" niacin on the market, but according to cardiologist Dr. William Davis, whose Heart Scan Blog is on our blogroll, it does nothing to reduce cholesterol or prevent heart disease. Dr. Davis says that taking niacin on a full stomach and drinking a couple of big glasses of water with it can reduce the flush.

I've been taking niacin for years and years, always in the regular, cheap, flush-causing form. Personally, I'm enough of a Baby Boomer to find the flush kind of a rush, so I haven't deliberately tried to suppress it. However, I do know that if you take it every day, the flush diminishes, I think because you're dumping your excess histamine on a regular basis, so there's less to be released. Dunno if this reduces allergic reactions; I'm not allergy-prone. I do know that I only flush about every third or fourth time I take niacin these days.

Be aware that at doses over 500 mgs per day -- I take 100 mgs per day -- niacin is more a drug than a vitamin, and can cause liver problems, just like statins. Doesn't mean you can't use it, but you'd want to get tested for liver function from time to time, as you would with statins.

One other thing, re the krill oil you're taking: Be aware that in some people omega-3 oils lower triglycerides more than LDL, which, thanks to that Friedewald equation, can give a false rise in LDL.

As you've gathered, I'm not a fan of statins, nor do I subscribe to the cholesterol theory of heart disease etiology. However, there is a group of people who have what is called "familial hypercholesterolemia" -- a genetic inability to properly metabolize cholesterol. People with this problem are, indeed, prone to increases in cholesterol from eating cholesterol (for most people dietary cholesterol has little effect on blood cholesterol) and higher rates of heart disease. And it may be that for people in this group, statins make at least some sense. (I am not a doctor. I do not play one on television. Do your research.) You may wish to be tested for this condition.

If, somewhere along the line, you decide you simply have to take statins, take large doses of the supplement CoQ10 along with them. Why? Because statins drastically deplete the body of CoQ10, which is, among other things, essential for your heart. There is now a recognized condition called "statin cardiomyopathy" -- heart muscle damaged from statin drugs -- and it is believed to be caused at least in part by CoQ10 deficiency.

You might also look into red yeast rice. This is actually a naturally-occurring statin drug, available as a supplement. Despite being natural, and being available over-the-counter, it is a drug. Please remember that "natural" is no guarantee of safety. Some people feel it is safer than the pharmaceutical statins -- Dr. Weil is one of these. I don't know enough to venture an opinion. If you were to go this route, you would still want to take CoQ10 and keep an eye wide open for possible statin side effects.