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The Cholesterol Dilemma

July 14, 2023

How can we best address cholesterol levels?

Many patients are consulting with me because they have high cholesterol levels in their blood tests.

They are questioning whether they should be on a cholesterol-lowering drug, called a statin, or just modify their diet and lifestyle to prevent the harmful effects of cholesterol.



Patients are warned that high levels of bad cholesterol (LDL, Low-Density Lipoprotein) and especially VLDL (Very Low-Density Lipoprotein) cause atherosclerosis. 

Atherosclerosis is the building up of plaque in the arteries, increasing the risk of heart attack and stroke.

They are also often told that good cholesterol (HDL, High-Density Lipoprotein) helps prevent cardiovascular disease. 

HDL helps transport cholesterol to the liver and clears it out of the blood circulation. Through this transport mechanism, HDL minimizes the building of plaque, and it is considered to be “good cholesterol”.

Whether high levels of HDL completely offset high levels of LDL is still unclear.

So, for a long time, patients with high LDL, regardless of their HDL and VLDL levels were put on a statin drug for the rest of their lives.


CoQ10 and Statins

If you have to take a statin drug, you need to also take CoQ10 to prevent muscle pain. Statins lower the levels of CoQ10 in the muscles, leading to cramps, leg, arm, and back pain.


The VAP study

The way we look at cholesterol levels in the blood has changed over the years.

I was a medical student when the VAP Cholesterol test came out, a study that looks at the cholesterol particles in more detail. I was tested because I had high cholesterol levels, just like my mother and everyone in her family lineage. Yet, everyone in her family has lived healthy into their late eighties. 

The cardiologist I was working with at that time decided that I was a good candidate for the VAP test which was going to show the precise nature of my cholesterol. I had been told to avoid meat, eggs, cheese, and fried foods and was surprised to hear that my low-fat diet didn’t make a difference and that, despite the higher-than-normal levels of LDL, I was not at high risk for cardiovascular disease. According to the VAP study, my cholesterol was made of “large buoyant particles from an A pattern” which, unlike small particles, don’t deposit in the arteries. 

This is a common pattern when cholesterol runs in families; inherited cholesterol circulates in the blood but doesn’t necessarily threaten individuals with a healthy lifestyle. 


Latest lab studies 

Today, many labs have extended the model of the VAP study with additional blood tests to assess cardiovascular health. Cleveland Heart Lab for instance uses a combination of blood sugar, inflammation, and cholesterol markers to determine cardiovascular risk.

More and more, we rely on these results, along with the patient’s lifestyle to decide whether or not a statin drug is needed.


What are Lipoproteins?

When we look at LDL levels, we have to consider the size of lipoprotein particles and the pattern, A (low risk) or B (high risk). 

Lipoproteins are particles made of protein and fats (lipids) and they transport cholesterol through the bloodstream into the cells. When lipoproteins are small and dense, rather than large and buoyant, they can infiltrate into the walls of the arteries and eventually create plaque. 

Small, dense LDL particles are also more susceptible to oxidation and cause Free radicals. High levels of free radicals can lead to damage and inflammation in the body.


How can you naturally lower LDL and increase HDL?

1- Reduce blood triglycerides 

-Reduce saturated fats, animal proteins (meat, poultry, dairy, eggs)

– Have a low-fat diet. No trans fats, found in fried foods, pre-packaged foods, especially sweets and snacks.

– Decrease white carbs (bread, pasta, rice, potatoe) and sugar from cakes and cookies.

2- Add flaxseeds and fibers to your diet.

Flaxseeds are lignans fibers that bind cholesterol and helps flushing it out of your system.

3- Take Omega 3s daily

Most of the western diet is rich in omega 6s and low in omega 3s fatty acids, found in fish, healthy oils, and some nuts. Omega 3s help with cardiovascular and brain health, so we need to supplement our diet. 

Omega 3s are made of DHA and EPA, which help with memory and mood as well. Using a supplement with a combination of both is best.

4- Maintain a healthy weight

Extra weight leads to inflammation in the body and causes “metabolic syndrome” which leads to heart disease, and early aging. Use an online BMI (Body Mass Index) calculator, plug in your weight, height, and age.

5- Exercise at least 3 times a week

A mix of cardio exercise, muscle work, and stretching provides the best benefits.

6- Lower stress levels

Stress increases inflammation which leads to the oxidation of cholesterol and cardiovascular disease.

Breathing exercises and meditation provide stress relief and many health benefits.

In summary, whether you have to take a statin or not, reducing inflammation is the most important step towards cardiovascular prevention.


Dr. Evee

Evelyne Leone, DO, FAARM, ABBARM

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