Dr. R. Golan

Q: My cholesterol is high. I want to reduce my risk of heart attack. But somehow I just can't see myself being a vegetarian for more than a week, nor can I see myself on a drug for the next several decades or more. What are some other ways to lower cholesterol?

A: Optimizing cholesterol levels is certainly important, and there are many natural and safe measures I recommend to my patients before considering cholesterol-lowering drugs. As you likely know, it is the total cholesterol — and specifically the unfavorable LDL cholesterol fraction — that we want to lower, while increasing the favorable HDL cholesterol fraction. Hereditary influences play a large role in determining these levels, but there is a significant effect that you can achieve from a combination of measures.

      Number one, you should ask your doctor to make sure that you do not have a sluggish thyroid. It is your liver's metabolism that largely controls your cholesterol levels, and how your liver metabolizes is largely controlled by your thyroid. I have seen cholesterol levels drop over 50 points from simply correcting a thyroid deficiency.
      Two well-known ways to lower blood cholesterol levels are to reduce dietary saturated fat and increase exercise. Both of these measures often help people to lose weight, too, which in itself will lower cholesterol levels significantly (as well as blood pressure). For instance, the well-known Ornish and Pritikin diets call for a drastic reduction of all kinds of fat.
      However, these high fiber, high complex-carbohydrate, low fat and vegetarian (or near vegetarian) diets do not work for a significant number of people. They cannot lose weight and cannot lower their cholesterol or triglyceride levels on what seems to be such a healthy diet, even with regular exercise. In my practice, I have seen many such discouraged patients in this situation. There seems to be an increasing percentage of our population for which a high carbohydrate diet is wrong. Carbohydrates raise blood sugar levels, which in turn stimulate the pancreas to secrete insulin, which lowers blood sugar levels. However, for many individuals a high or relatively high-carbohydrate diet will cause an excess of insulin, with many unfavorable effects: increased storage of fat, weight gain, less favorable cholesterol/HDL ratio, inflammation and other problems.
      When protein is eaten, however, it stimulates the pancreas to release another hormone, glucagon, which triggers the opposite effects of insulin. It causes the body to burn fat, lose weight, raise HDL cholesterol levels, lessen inflammation and more. It is through sugar reduction and even the healthy complex carbohydrate reduction that triglyceride levels also come down. For these reasons, in recent years we have seen many proponents of higher protein/lower carbohydrate diets (which are not necessarily very low in fat) for weight control, cholesterol control and health maintenance.
      It is not easy for me to determine the optimal diet for each of my patients. As awkward as this may sound, it often requires trial and error, like many things in modern medicine. There is no one diet that is correct for everyone. Hopefully, your doctor, nutritionist or other health-care practitioner can steer you in the right direction.
      In addition to adjusting the diet, I often recommend supplemental fiber, primarily a soluble type such as oat bran, which binds to intestinal cholesterol and facilitates its excretion. In so doing, the liver is obligated to secrete more cholesterol into the intestine and less into the bloodstream — thereby lowering total and LDL cholesterol levels. Fiber also encourages the growth of the favorable intestinal acidophilus and bifidus bacteria. One function of these organisms is to produce acetic acid — which inhibits cholesterol synthesis in the liver and therefore lowers blood levels of cholesterol.
      Several nutritional supplements also can lower total and LDL cholesterol levels and raise HDL cholesterol: the vitamins C, E, niacin and B-6; the minerals chromium, magnesium and copper; the amino acid N-acetylcysteine; the essential fatty acids in omega-3 fish oils and flax oil; and garlic (as a supplement or added to food). An ayurvedic herb, gugulipid, an extract from the Indian mukul myrrh tree, is also an effective agent for improving cholesterol levels. I recommend many of these to my patients, in combination formulas and as single agents.
      Stress reduction also may help. A study in an Israeli medical journal demonstrated a 20 percent drop in total cholesterol levels in participants who did a relaxation exercise just five minutes twice a day. There is a huge body of research suggesting that how we handle stress can determine in no small way our susceptibility to heart disease and many other illnesses.
      For those with significant arterial disease, I will recommend chelation therapy, an intravenous nutritional/medical treatment which can safely reverse plaque. Some physicians use it preventively as well. I believe that thousands of yearly coronary bypass surgeries could be prevented if chelation therapy became widely accepted.
      It is mostly what we can do for ourselves that can help prevent heart attacks: the right diet, nutritional supplements, exercise, relaxation and stress management. Drugs have their place in this big picture, but a much smaller place, I personally believe, than modern medicine has given them. If just one of these self-care measures can significantly decrease cholesterol levels or minimize other cardiac risks, it would not be a big stretch to say that the combined effects of implementing the whole program could have a profound effect, not just on cholesterol levels and heart disease, but on total health.

                                                                                
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