I had a medical checkup about a year ago. I felt great, but I was preparing to get married and wanted to make sure I didn’t have any health problems.
The only bad news was high cholesterol. I was disappointed because I hoped I had inherited my dad’s tendency for low cholesterol (he and other paternal relatives normally have total levels in the 150’s).
I should clarify something here: my blood lipid profile wasn’t all bad news. My triglycerides were at very healthy (low) levels, and my HDL/LDL ratio was also good. I decided to do two things after seeing the test results: 1. Learn everything I could about cholesterol 2. Lower my cholesterol through diet, exercise, and supplementation.
Cholesterol: an Introduction
Let me first say this: I’m not a doctor and I have discussed many of these issues with my physician. I’d suggest you do the same.
I’m sure most of you are familiar with cholesterol–it is a waxy, fat-like substance found in all cells of the human body. It plays a crucial role in the synthesis of hormones and other substances. But high levels of LDL (the “bad” cholesterol) are associated with the accumulation of plaque in the arteries and heart disease.
The link between high cholesterol and heart disease is controversial, and some doctors/scientists have pointed out flaws in the research. I do understand these points, especially considering the financial gains to be made by marketing statins and other drugs (more on that later). But trying to decrease my LDL levels seemed like a good idea when considering the majority of the medical evidence.
Particle Size
The most important thing I learned was the importance of particle size. This is a relatively new development in our understanding of the link between cholesterol and cardiovascular disease. It seems not all LDL cholesterol particles are equally harmful–smaller particles seem to more easily penetrate the arterial lining and do more damage, but larger, “fluffy” particles are good news. Here’s a crude analogy: imagine the difference between throwing a beach ball vs a small rock at a window.
High triglycerides and low HDL are associated with small particle size.1 Dividing triglycerides by HDL is, in fact, a fairly accurate way to measure this risk factor–less than a 2.0 ratio (American units) would usually indicate a healthier lipid profile (larger particles).2 In other words, one of the simplest ways to determine your particle size is to divide your triglyceride number by your HDL. A number under 2 means you mostly have the (safe) larger particles, but a number over 3 is a risk factor for heart disease.
A new testing method called the VAP is now available as a follow-up to the standard cholesterol test. This is what I’d recommend for those who want more definitive information on their particle size. I believe this test will become more widely available and more commonly used in the future.
Statins
I also studied statins, drugs that interfere with the liver’s ability to produce cholesterol. These drugs are effective, but side effects such as muscle pain/weakness seem to be fairly common. Professional athletes, for example, usually discontinue statin therapy due to these issues.3 There’s also some evidence that suggests statins may reduce testosterone levels and libido.4 For the record I should say that the benefits of these drugs might outweigh the risks for many patients based on the overall research.5 I also think some of the side effects of statins may be reduced/eliminated by simply supplementing with CoQ10 (though research hasn’t confirmed this to my knowledge). But I wanted to try to avoid this type of medication after considering all the evidence.
A Helpful Book
One of the most helpful resources I ran across was The New 8-Week Cholesterol Cure (by Kowalski)
What I Did
Phase 1: Diet, Exercise and Regular (Immediate Release) Niacin
Exercise: I continued training with weights 3-4 times a week as before. Exercise is known to lower cholesterol and should be part of any health regimen.
Diet: I did not eliminate anything from my diet–I knew that wouldn’t work for me. But I did reduce my intake of foods that I knew would be bad for my cholesterol. I cut back on fried foods, fast foods, pork and red meat. Most of the time we eat chicken or fish here at home (baked or steamed). In other words, I ate healthy most of the time.
I also ate a big bowl of oatmeal very regularly (pun intended). Oatmeal and other high fiber foods basically pull cholesterol out of the body. This fact has been well established by several studies (oatmeal manufacturers are actually allowed by the FDA to make health claims on their labels because of this).
I followed a form of intermittent fasting to keep my calories in check and keep my body fat level low.
Supplements: The most important supplement I took was niacin. The before-mentioned book has a whole chapter on the role of niacin in healthy blood lipids. This vitamin, when taken at high dosages, is particularly effective for raising HDL levels.6 It also lowers levels of LDL and VLDL.7
I took 1,000 milligrams of regular niacin every night before going to sleep. A more effective strategy would be taking it throughout the day, but I wanted to see how effective this simple approach would work. I usually experienced the skin flush associated with taking this supplement, but I simply don’t trust most of the “no-flush” formulas out there. It didn’t bother me as much since I was in bed in our air-conditioned room.
One word of caution: It is very important to have your liver checked if you want to use niacin at the doses required to improve blood lipids. Niacin at these levels would be considered a “drug” instead of just a “supplement.”
I also took 3-4 grams of fish oil per day. This supplement has multiple benefits, and I would have taken it regardless of my cholesterol test results.
Initial Results
I dropped my cholesterol level by about 40 points. My overall cholesterol and LDL were at “borderline” levels, and my ratios were still good. My liver test also came back normal. My doctor was pleased with the change in blood lipids (he seemed a little surprised). I have no other risk factors (hypertension, diabetes, etc), so he was comfortable allowing me to continue with what I was doing.
Phase 2: Wax Matrix Niacin (750 mg/day)
I was pleased to see some improvements, but I really wanted to get my cholesterol down to a healthier level. I decided to switch from regular (immediate release) niacin to a wax matrix niacin called endur-acin (available at Endurance Products). This is the only sustained release formula recommended in the before-mentioned book, and the research (though limited) seems favorable.8 My doctor gave me the nod to try it, so I started out with 750 milligrams a day.
Let me highlight something here: I would not recommend the “extended release” niacin formulas you typically see in drug stores–stick with wax matrix niacin.
Here’s another important note: extended release niacin formulas must be treated as if they were double the dose of regular (“immediate release”) tablets as far as your liver goes. Taking 500 mg of the Endur-Acin, for example, would be the equivalent of 1000 mg regular niacin (something else I learned from the 8-week Cholesterol Cure).
About six months passed before I was tested again (I should not have waited this long and didn’t intend to, but life happens). My overall cholesterol level was about the same (still at borderline levels), but some of my ratios had moved in unfavorable ways. I wasn’t too surprised since holiday season/eating had just passed and we had also experienced a death in my family. My exercise and diet weren’t exactly ideal in the weeks leading up to this test. But my liver enzymes were completely normal, meaning I was tolerating the new niacin formulation. I told my doctor I’d like to try the full dosage (1,500 mg).
Phase 3: Wax Matrix Niacin (1,500 mg/day)
I took 1,500 mg of Endur-Acin a day: one 750 mg tablet in the afternoon and another after dinner (three 500 mg tablets would have been more ideal, but I don’t always eat 3x a day). I’ll mention something else here–another benefit to wax matrix niacin is you don’t experience the “flush” associated with regular (immediate release) niacin. I occasionally feel a slight tingling sensation, but nothing like when I was taking regular niacin.
I also added phytosterols and pantethine (as recommended by Kowalski) after a few weeks.
My diet and training were also back on track. I wasn’t 100% consistent, but much better than the holidays.
Success!
I had another test done about seven weeks after starting this new regimen. I was pleasantly surprised with the result–my total cholesterol was under 200 (lower than it was when I was in my 20’s). I wasn’t expecting such a drastic improvement. I don’t feel comfortable publishing my exact profile numbers (just a privacy thing), but my ratios are all healthy.
My liver enzymes are slightly elevated, but this is very common for someone taking any form of supplement/medication for cholesterol, including statins (I was expecting this, and the slight elevations didn’t concern my doctor).
Phase 4: Maintenance
I had one more test done about seven weeks after the “phase 4” date. My numbers/levels were almost identical to the previous test.
My cholesterol is now safely under control through supplements, diet, and exercise. I consistently take 1,250-1,500 mg of the wax matrix niacin daily, but I don’t always use phytosterols and pantethine. I also take (drink) a teaspoon of a sugar-free psyllium fiber supplement almost every day with dinner (this specific type of fiber helps reduce cholesterol, and I can take it without adding carbs/calories to my diet).
More on Statins:
What if this strategy had not worked? I was prepared to bite the proverbial bullet and take medication (my legendary stubbornness does have its limits). My doctor had already written a prescription for rosuvastatin (Crestor) after my “phase 2” test.
But I probably would have talked to my physician about taking a much lower dose than the standard 10 mg. I would recommend considering the following options if you can’t get your cholesterol under control through diet/supplements:
Intermittent therapy: subjects in one study significantly lowered their LDL cholesterol and triglycerides by taking 5 mg of rosuvastatin 2-3 times a week. Even a once-a-week dose lowered LDL by 23%.9
Low dose therapy: I was surprised to learn that just 2.5 mg/day of rosuvastatin can lower LDL by a whopping 42%, and just 1 milligram per day will typically lower it by 34%.10 You’d need a pill cutter for this strategy, since (for reasons unknown) the smallest available dosage of rosuvastatin is 5 mg.11
Final Thoughts:
I’m not necessarily opposed to statins (or any other drug, for that matter). But I decided to take a different route for improving my health. I hope this post (and the resources mentioned) will help you made decisions about what is best for you.
I’ll remind you one last time–please talk with your doctor about this and get medical supervision.
See Also: Niacin and Fat Loss
References:
1. Mayo Clinic: A New Way to Measure Cholesterol: Particle Size Indicates Risk
2. J Atheroscler Thromb. 2003;10(3):186-91. Assessment of LDL particle size by triglyceride/HDL-cholesterol ratio in non-diabetic, healthy subjects without prominent hyperlipidemia.
3. Br J Clin Pharmacol. 2004 April; 57(4): 525–528. Professional athletes suffering from familial hypercholesterolaemia rarely tolerate statin treatment because of muscular problems
4. Br J Clin Pharmacol. 2004 September; 58(3): 326–328. Is decreased libido associated with the use of HMG-CoA-reductase inhibitors?
5. J Am Coll Cardiol.2012 Sep 4;60(10):875-81. Epub 2012 Aug 15. The controversies of statin therapy: weighing the evidence.
6. N Engl J Med September 22, 2005; 353:1252-1260 Low HDL Cholesterol Levels
7. J Intern Med.2005 Aug;258(2):94-114. Nicotinic acid: the broad-spectrum lipid drug. A 50th anniversary review.
8. J Clin Lipidol. 2012 Mar-Apr;6(2):121-31. doi: 10.1016/j.jacl.2011.07.003. Epub 2011 Jul 23. A systematic review on evidence of the effectiveness and safety of a wax-matrix niacin formulation.
9. Curr Med Res Opin. 2012 Mar;28(3):371-8. doi: 10.1185/03007995.2012.657302. Epub 2012 Feb 7. Daily and intermittent rosuvastatin 5 mg therapy in statin intolerant patients: an observational study.
10. Am J Cardiol. 2001 Sep 1;88(5):504-8. Effect of rosuvastatin on low-density lipoprotein cholesterol in patients with hypercholesterolemia.
11. The Lancet, Volume 364, Issue 9445, Page 1579, 30 October 2004 doi:10.1016/S0140-6736(04)17304-2 Should rosuvastatin be withdrawn from the market? Jay S. Cohen
