"Essential reading for anyone with high cholesterol
or who is taking statins"
Why do I keep hearing people say that they don’t need to be careful anymore about what they eat, now that they’re ‘on statins’ ?
For those who don’t know, statins are a family of drugs prescribed extensively to manage elevated cholesterol levels. A common but erroneous belief is that statins will save you from having to bother about eating anything other than the rubbish diet of your heart’s desire. ‘Mostly I eat what I want; red meat, pizzas and fry-ups are my favourites’, someone said to me recently. Another laughed that vegetables and salads were only consumed ‘under pressure from the wife’ but that he was ok without 'all that green stuff' because he had 'some tablets from the doctor'.
I wish I could say that these were isolated incidents. But, if my experience and that of other health professionals in practice is anything to go by, they’re not. There seems to be a widespread consensus that if you have a problem with cholesterol, the only effort you have to make is to take the medication or adopt the ‘a heart attack won’t happen to me’ approach. At the other extreme are people who are so convinced of their imminent demise that they give up anything and everything that has ever been remotely linked to elevated cholesterol or coronary heart disease - whether the information is correct or not!
If you fit into any of these categories, please, stop right there! We need to talk.
For sure, high cholesterol is believed, by the majority of the medical profession and a whole load of researchers, to be one of several factors to consider when whether a patient might be at risk of stroke or heart attack. But others, just as eminently qualified, completely disagree. It's certainly the case that smoking, high blood fats called triglycerides, high blood pressure, diabetes, being overweight and excessive stress are also vital to consider when assessing stroke and heart attack risk. However, cholesterol levels can go up in the presence of other illnesses that have little or nothing directly to do with the heart or circulation; obesity and Type 2 diabetes among them. It may also be high where there are thyroid problems and hormonal disruption, for example in polycystic ovary disease (PCOS).
Nevertheless, 'cholesterol' is not an illness. Whilst it's important to emphasise that the condition known as familial hypercholesterolaemia is a separate condition and is not discussed in this article, a small increase in LDL cholesterol over and above the usual upper limits set by doctors is almost certainly nothing to worry about. A lot of medication is prescribed unnecessarily because readings are just one or two points above what is considered 'normal' (see the paragraph below GOOD VERSUS BAD - THE CHOLESTEROL BASICS). Unfortunately, the cholesterol issue is mired in misinformation to the extent that much of it is now accepted as absolute fact. Such as the belief that cholesterol bungs up the arteries, causing a blockage which leads to a heart attack. What actually happens is that the endothelium, the lining of the artery wall, gets damaged (scarred if you like) and this leads to what we know as atherosclerosis. A good analogy of this is when someone suffers a graze or cut to the skin and a protective cover is formed which we call a scab. Imagine this happening inside your arteries and you can see that, if too many scabby bits or scars to the endothelium get in the way, it will affect the flow of blood to the heart. But this is not caused by cholesterol.
INFLAMMATION: Research suggests that lowering inflammation (see pages 180 and 254 of Good Gut Bugs) may be equally important in the fight against heart disease. For example, even if you reduce LDL cholesterol but still have high levels of inflammation (your doctor can test for this by checking for a particular inflammation marker known as C-reactive protein and another substance creatine kinase which is released into the bloodstream where there is inflammation of muscle tissue), statins could be of no use to you. High levels of C-reactive protein can be a valuable indicator of heart attack risk. If there is any benefit at all to be had from statins, it may be linked more to their ability to reduce inflammation rather than any cholesterol-lowering action.
Nevertheless, 'cholesterol' is not an illness. Whilst it's important to emphasise that the condition known as familial hypercholesterolaemia is a separate condition and is not discussed in this article, a small increase in LDL cholesterol over and above the usual upper limits set by doctors is almost certainly nothing to worry about. A lot of medication is prescribed unnecessarily because readings are just one or two points above what is considered 'normal' (see the paragraph below GOOD VERSUS BAD - THE CHOLESTEROL BASICS). Unfortunately, the cholesterol issue is mired in misinformation to the extent that much of it is now accepted as absolute fact. Such as the belief that cholesterol bungs up the arteries, causing a blockage which leads to a heart attack. What actually happens is that the endothelium, the lining of the artery wall, gets damaged (scarred if you like) and this leads to what we know as atherosclerosis. A good analogy of this is when someone suffers a graze or cut to the skin and a protective cover is formed which we call a scab. Imagine this happening inside your arteries and you can see that, if too many scabby bits or scars to the endothelium get in the way, it will affect the flow of blood to the heart. But this is not caused by cholesterol.
INFLAMMATION: Research suggests that lowering inflammation (see pages 180 and 254 of Good Gut Bugs) may be equally important in the fight against heart disease. For example, even if you reduce LDL cholesterol but still have high levels of inflammation (your doctor can test for this by checking for a particular inflammation marker known as C-reactive protein and another substance creatine kinase which is released into the bloodstream where there is inflammation of muscle tissue), statins could be of no use to you. High levels of C-reactive protein can be a valuable indicator of heart attack risk. If there is any benefit at all to be had from statins, it may be linked more to their ability to reduce inflammation rather than any cholesterol-lowering action.
IT'S
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There are a whole batch of things that doctors rarely test for that are incredibly useful when trying to suss out if someone is at risk of heart attack or stroke. These include levels of red cell magnesium, fibrinogen - a protein involved in clot formation, blood viscosity, something called VLDL or Very Low Density Lipoprotein and lipoprotein-a, a potentially damaging type of cholesterol associated with inflammation of the arteries, as well as a useful marker of inflammation, the above-mentioned C-reactive protein. I cannot repeat this too often: If you are being told you need medication, ask if you have had these and the tests mentioned above. Prescribing statins on the basis of one basic cholesterol test is SIMPLY NOT ACCEPTABLE.
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THE GOOD NEWS: What’s hardly ever mentioned is that cholesterol is an essential nutrient, a building block for all cell membranes and hormones. So it’s something we need. Like everything in life, we just don't need it to excess.
TOO MANY INCONSISTENCIES
GOOD VERSUS BAD - the cholesterol basics
Most people are aware that doctors talk about two main types of cholesterol. The one usually called bad cholesterol we know as LDL, which stands for low-density lipoprotein. The other is high-density lipoprotein (HDL) which is said to be 'helpful cholesterol' because it works to keep LDL in check. In fact, the good/bad cholesterol thing is a very simplistic view as both are necessary in the body. It's already been suggested by researchers that the 'good' cholesterol (HDL) helps lower the risk of Alzheimer's and, ironically, of coronary heart disease too! Some research also puts forward the view that when cholesterol falls too low, it can increase our risk of cancer.
WHAT'S YOUR LEVEL?
In line with most current medical recommendations, your total cholesterol should be between 150 & 200 mg/dl (or in UK measurements, 3.9 mmol/l – 5.17 mmol/l). But it’s the ratio of the HDL to the LDL that’s almost more important. To give you an idea, my total cholesterol is 4.9 (189mg/dl) which is on the higher end of normal but, in fact, my LDL is low and my HDL makes up the healthy difference so the results are, in fact, excellent. Always keep in mind that slight variations of the ideal may occur depending upon which lab did your test but what you should be aiming for is LDL below 150mg/dl (UK: 3.9 mmol/l) and HDL below 60 mg/dl (UK: 1.55 mmol/l). If either of these figures is slightly elevated by 5 or 10mg (UK: 0.13 - 0.26 mml/l) then this is still ok and nothing to worry about. It may be worth mentioning here that, not so long ago, the upper healthy limit of total cholesterol was 6.1 mmol/l (EU: around 231mg/dl). There is a school of conspiracy theorists that is convinced the levels were changed only to accommodate pharmaceutical companies who wanted to sell more statins. Of course, I have no idea if this is true so could not possibly comment.
WHAT'S YOUR LEVEL?
In line with most current medical recommendations, your total cholesterol should be between 150 & 200 mg/dl (or in UK measurements, 3.9 mmol/l – 5.17 mmol/l). But it’s the ratio of the HDL to the LDL that’s almost more important. To give you an idea, my total cholesterol is 4.9 (189mg/dl) which is on the higher end of normal but, in fact, my LDL is low and my HDL makes up the healthy difference so the results are, in fact, excellent. Always keep in mind that slight variations of the ideal may occur depending upon which lab did your test but what you should be aiming for is LDL below 150mg/dl (UK: 3.9 mmol/l) and HDL below 60 mg/dl (UK: 1.55 mmol/l). If either of these figures is slightly elevated by 5 or 10mg (UK: 0.13 - 0.26 mml/l) then this is still ok and nothing to worry about. It may be worth mentioning here that, not so long ago, the upper healthy limit of total cholesterol was 6.1 mmol/l (EU: around 231mg/dl). There is a school of conspiracy theorists that is convinced the levels were changed only to accommodate pharmaceutical companies who wanted to sell more statins. Of course, I have no idea if this is true so could not possibly comment.
CHOLESTEROL CONVERSION CHART
If you are tested in the United Kingdom, your total cholesterol, LDL and HDL (and your triglycerides - the fats in your blood) will all be measured in millimoles per litre written like this: mmol/l.
If you're tested in a European country, then the readings are given in milligrams per decilitre written as: mg/dl. To convert from one to the other is a breeze. The box opposite tells you how. If you don't want to do this yourself and need a bit of help (my maths is appalling so I love conversion charts!) then try these websites: http://www.onlineconversion.com/cholesterol.htm http://www.endmemo.com/medical/unitconvert/Low-density_lipoprotein_cholesterol.php (If the individual boxes on this particular chart don't work, then use the batch boxes on that page to calculate) |
CHOLESTEROL
To convert to EU from UK measurements: Take the UK reading for TOTAL CHOLESTEROL, LDL or HDL in mmol/l and then multiply by 38.6 To convert to UK from EU measurements: Take the EU reading for TOTAL CHOLESTEROL, LDL or HDL in mg/dl and then divide by 38.6 TRIGLYCERIDES To convert to EU mg/dl from UK measurements: Take the UK reading for TRIGLYCERIDES in mmol/dl and multiply by 88.5 To convert to UK mmol/l from EU measurements: Take the EU reading for TRIGLYCERIDES in mg/dl and divide by 88.5 |
I’m sure you’d agree that medicines should never be taken unless there is real need. All drugs can have adverse reactions and statins are no exception. My Important Note About Prescriptions may be of interest on this point. Although claimed to affect only a small number of patients, side effects for statins can include nausea, headaches, mood swings, bowel disturbance, upset stomach, changes in liver function and pain, inflammation or weakness of the muscles. And this is just the short list! The full list of potential side effects, to me at least, seems terrifying. There has also been plenty of patient feedback suggesting that memory loss, all too easy to blame on advancing years, may be caused or aggravated by these drugs.
Co-Enzyme Q10
Is it an essential nutrient
for those taking statins?
It would seem so. One of the most bothersome side effects is that statins can affect the manufacture of a vital substance known as co-enzyme Q10 (also called CoQ10 or sometimes labelled quinone or bio-quinone) which is needed not only for energy production but also for healthy muscles, including - guess what - the heart. For this reason, a daily supplement of CoQ10 could be especially important for anyone over 65 and for people with inherited high cholesterol known as familial hypercholesterolemia.
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Several years ago, I was privileged to meet and talk at length with the head of Denmark’s heart transplant programme who has used Bio-Quinone Q10 successfully with many of his patients and he told me his work showed a regular daily CoQ10 capsule was an excellent addition to a healthy diet. (He also used Bio-Quinone Q10 very successfully as part of his treatment programme for patients suffering cardiomyopathy - deterioration of the workings of the actual heart muscle).
Because statin drugs are also known to lower blood levels of vitamin E, another nutrient needed for heart health, it could be a wise move to talk to your health care professional about supplementing these important nutrients. My favourite CoQ10 products are shown on this page together with direct links for more information. Perhaps you might also consider investing in a best quality multi-supplement that contains a range of ingredients that have really punchy anti-oxidant capability. |
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Note: I always recommend to anyone suffering high cholesterol or who has a history of heart disease or heart attack to take a quality fish oil supplement along with CoQ10 and Vitamin E, whether or not they are taking statins. The benefits of Omega 3s to the cardiovascular system are well documented. In a major scientific study of more than 18,000 patients with high cholesterol, it was found that supplementation with 1.8 grams of EPA daily, together with a statin, reduced what the researchers referred to as ‘major cardiovascular events’ by 19% compared to a statin alone.
THE CONFLICTING ADVICE ON STATINS
CAN BE VERY CONFUSING FOR THE CONSUMER
As the Pharmaceuticals Correspondent of the Financial Times puts it: "One camp believes lives can be saved by expanding use of cholesterol-lowering statins, the other thinks such a move would unnecessarily “medicalise” millions of healthy people." So should they be prescribed, as one study suggests, on a 'just in case' basis even to healthy people who show no risk of high cholesterol or heart disease? Wouldn't this just mean millions of non-sufferers being stuck on statins for the rest of their lives with no apparent advantage? Or should statin prescribing be limited only to those with a history of cardiovascular disease? And if statins are saving lives, are the number of lives saved worth the cost and the risk?
I was also interested to read the Oxford University study reported in the British Medical Journal which has calculated that an apple a day could prevent around 8500 deaths each year from stroke and heart attack. Although, they say, apples are more expensive statins (are they?), the researchers conclude that an apple a day is able to match the more widespread use of modern medicine. So although they don't directly compare one with the other, there is no doubt about their message which is that if lots of us ate more healthily, medications such as statins might not be needed so often.
WHATEVER THE ANSWERS TO THESE QUESTIONS, MY ADVICE REMAINS THE SAME
I was also interested to read the Oxford University study reported in the British Medical Journal which has calculated that an apple a day could prevent around 8500 deaths each year from stroke and heart attack. Although, they say, apples are more expensive statins (are they?), the researchers conclude that an apple a day is able to match the more widespread use of modern medicine. So although they don't directly compare one with the other, there is no doubt about their message which is that if lots of us ate more healthily, medications such as statins might not be needed so often.
WHATEVER THE ANSWERS TO THESE QUESTIONS, MY ADVICE REMAINS THE SAME
- Eat as healthily as you can. My feature Colour Your Way To A Healthier Diet has lots of ideas.
- Always find out as much as possible about any proposed medication before you take it and if you're not happy with the medical advice you are receiving, don't be afraid to push for a second opinion. Click this link to read An Important Note about Prescription Medicines.
- If you are on statins or intend to take them, then also include the best CoQ10 product that you can afford.
- There are experts who argue that chasing cholesterol levels has not only become an obsession, at best a waste of time, at worst potentially dangerous. Check out the writings of Dr Malcolm Kendrick. He has written a must-read book called The Great Cholesterol Con.
ACCORDING TO DR KENDRICK, the latest heart disease statistics reveal some extremely interesting facts. Such as:
"People with high cholesterol tend to live longer
People with heart disease tend to have low levels of cholesterol
Cholesterol-lowering of a population does not reduce the rate of heart disease and . . .
. . despite their widespread use, and description as “wonder drugs” statin medications do not extend life for the majority of people who take them."
Click here to watch Dr Kendrick's most excellent video The Statin Nation
"People with high cholesterol tend to live longer
People with heart disease tend to have low levels of cholesterol
Cholesterol-lowering of a population does not reduce the rate of heart disease and . . .
. . despite their widespread use, and description as “wonder drugs” statin medications do not extend life for the majority of people who take them."
Click here to watch Dr Kendrick's most excellent video The Statin Nation
OTHER NUTRIENTS ARE IMPORTANT TOO!
Apart from co-enzyme Q10 and vitamin E, pycnogenol also known as pine bark extract, the amino acid L'Arginine (see below), selenium and carotenoids could all be valuable. I always recommend Vitamin C too as, not only has it been shown to reduce arterial plaque, it also helps to curb a substance called C-Reactive Protein, an indicator of inflammation, high levels of which can contribute to cardivascular disease. A word of advice: buy the best that you can afford. I’ve studied supplement quality extensively over the years and it’s my view that cheaper products are not so well absorbed or assimilated and can be a waste of money.
CONSIDER L-ARGININE
In 1997 Dr Rainer H Boger based at the Hanover School of Medicine in Germany carried out a medical study comparing the action of the amino acid L-Arginine with Lovastatin (marketed as Mevacor). The results of his research were published in the American Heart Association Journal, Circulation, and showed that L-Arginine was just as effective as the statin drug at reducing LDL, often referred to as 'bad' cholesterol. Other research has been conflicting. Some studies do show that L-Arginine appears to raise total cholesterol and also that it may influence 'good' cholesterol, the HDL. Having read a stack of research on this, it seems to me to be the case that L-Arginine is well worth trying, especially for anyone who is having a hard time coping with the side effects of statins. There is good evidence that L-Arginine reduces the side effects so often associated with taking statins. The world wide web has a ton of excellent articles about this amino acid. Just Google L-Arginine and Cholesterol. However, a word of caution. Don't stop taking prescribed cholesterol medication without first discussing statins and L-Arginine with your medical adviser.
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If you do nothing else, at least please try to introduce these changes below, all of which should help improve heart health:
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SIX STATIN SUGGESTIONS
- If statins are prescribed to you and you have no history of heart disease and normal levels of cholesterol, don't be afraid to question the doctor - before you take the drug - on why this step is being suggested. I’m not suggesting for a moment that anyone should cease taking existing medication; only consider such a move with the full knowledge and support of your medical adviser. But don't be nervous about asking for more information. After all, it's your body and your health.
- If you are on statins, don't forget to talk with your doctor about possible interactions and contraindications with other drugs or existing health conditions. Most GPs don't discuss side effects. If you have started on the drug and are experiencing symptoms you've not had before, then definitely go back for advice. Statins have many unpleasant side-effects - memory loss, joint pain and higher risk of cataracts among them. Also, do consider discussing the possibility of taking a break from statins and asking for more information about why they were prescribed in the first place. For example, were they recommended on the basis of just one cholesterol test or are there other tests that suggest there may be a problem - such as high blood pressure, high levels of fibrinogen, C-reactive protein or blood viscosity, elevated triglycerides, very low density lipoproteins (VLDL) or lipoprotein-a. The free and easy way that statins are prescribed worries me hugely. I was contacted only last week by someone who was concerned because their doctor had recommended statins on the basis of a single cholesterol reading. When I studied the blood test results for this person, I found that the LDL cholesterol was normal and the HDL (what we have come to know as 'good' cholesterol - although it really isn't as simple as saying one is good and one is bad) was only slightly elevated. And the ratio between the two figures was excellent. Certainly not a case for medical intervention but, sadly, prescribing statins in such circumstances is not an isolated situation.
- If you need to take antibiotics or anti-fungal medication and you're on statins, make sure that you talk with your doctor because both these drugs can interact adversely with statin drugs. Grapefruit juice affects the metabolism of most statins so this normally healthy drink is best avoided by statin users. Remember, too, that some nutrient supplements cannot be taken with certain medications so, again, don’t start any supplement programme without first talking to your regular health care provider.
- Very important: have a chat with your GP about using a good quality Co-enzyme Q10 (at least 30mg daily) plus a Vitamin E supplement. And keep in mind that he or she may not know that statins cause depletion of these vital nutrients.
- Never rely on one person's advice. If you're unsure about the advice you are getting, then consider a second opinion. And get tested. I repeat: if your doctor is recommending statins merely on the basis of a high cholesterol reading, ask for more information and more tests as per those I have detailed above. One high cholesterol result is not a good enough reason for a lifetime on statin drugs. Read as much as you can on the subject. Stay savvy and be well informed at all times. It can help to learn a bit about how cholesterol works in the body. Most people don't realise that it is an essential nutrient. The Healthline website www.healthline.com has some excellent articles and illustrative videos that are well worth watching. And remember that while friends and family can be well-meaning, unless they are qualified health professionals, their advice might not be appropriate to your particular health condition. The links and recommended reading at the foot of this article may be of further assistance.
- Being on statins does not mean that you can eat what you like and no harm will come to you. A healthy diet and sensible exercise routine are both important whether you are on medication or not.
*** The condition known as familial hypercholesterolaemia is a separate cholesterol issue and requires specialist medical support and treatment.
In the meantime, I wish you the best of better health.
Kathryn Marsden
© Kathryn Marsden 2007/2008/2009/2010/2011/2014/2015/2017/2018
USEFUL LINKS:
Sarah Stacey's Daily Mail feature on Cholesterol ;The Big Fat Lie' 12th July 2015
If you can't get the link you can read a plain text copy here
If you can't get the link you can read a plain text copy here
Click here to read . . .
An Important Note About Prescriptions
What About Vitamin & Mineral Supplements?
Colour Your Way to a Healthier Diet
OTHER RECOMMENDED READING:
The Great Cholesterol Con by Dr Malcolm Kendrick
Ignore the Awkward by Uffe Ravskov
Good Gut Bugs by Kathryn Marsden (Chapter 13 Cholesterol & Other Heart Disease Risk Factors)
TAKING STATINS - NECESSARY OR NEEDLESS?
http://www.huffingtonpost.com/2013/05/16/simvastatin-exercise-obese-people-statin-drugs-zocor_n_3288101.html
http://www.bbc.co.uk/news/health-22636666 (some statins may increase diabetes risk)
http://www.thecholesteroltruth.com/pages/about-the-cholesterol-truth?gclid=CPfircT72qoCFcVO4Qodig6f8w
http://www.bbc.co.uk/news/health-12224312
http://alzheimers.org.uk/site/scripts/news_article.php?newsID=860
http://www.nhs.uk/news/2011/06June/Pages/anti-cholesterol-statin-pills-diabetes-risk.aspx
http://www.cholesterol-and-health.com/Coenzyme-Q10.htmlhtml
http://www.theguardian.com/society/2014/jun/10/statins-low-risk-heart-disease-rethink-doctors-nice
http://www.ox.ac.uk/media/science_blog/120517.html
http://www.nhs.uk/News/2011/06June/Pages/anti-cholesterol-statin-pills-diabetes-risk.aspx
https://www.nhs.uk/news/heart-and-lungs/study-says-theres-no-link-between-cholesterol-and-heart-disease/
http://www.huffingtonpost.com/2013/05/16/simvastatin-exercise-obese-people-statin-drugs-zocor_n_3288101.html
http://www.bbc.co.uk/news/health-22636666 (some statins may increase diabetes risk)
http://www.thecholesteroltruth.com/pages/about-the-cholesterol-truth?gclid=CPfircT72qoCFcVO4Qodig6f8w
http://www.bbc.co.uk/news/health-12224312
http://alzheimers.org.uk/site/scripts/news_article.php?newsID=860
http://www.nhs.uk/news/2011/06June/Pages/anti-cholesterol-statin-pills-diabetes-risk.aspx
http://www.cholesterol-and-health.com/Coenzyme-Q10.htmlhtml
http://www.theguardian.com/society/2014/jun/10/statins-low-risk-heart-disease-rethink-doctors-nice
http://www.ox.ac.uk/media/science_blog/120517.html
http://www.nhs.uk/News/2011/06June/Pages/anti-cholesterol-statin-pills-diabetes-risk.aspx
https://www.nhs.uk/news/heart-and-lungs/study-says-theres-no-link-between-cholesterol-and-heart-disease/
http://circ.ahajournals.org/content/98/18/1842.full
Boger RH et al. L-Arginine enhances the triglyceride-lowering effect of simvastatin in patients with elevated plasma triglycerides. Nutrition Research 2009;29(5):291-7. doi: 10.1016/j.nutres.2009.04.004.
http://www.ncbi.nlm.nih.gov/pubmed/19555809
Boger RH et al. L-Arginine enhances the triglyceride-lowering effect of simvastatin in patients with elevated plasma triglycerides. Nutrition Research 2009;29(5):291-7. doi: 10.1016/j.nutres.2009.04.004.
http://www.ncbi.nlm.nih.gov/pubmed/19555809
Kathryn's views are completely independent. She is not employed by any pharmaceutical company, supplement supplier or food producer nor is she persuaded in any way, financially or otherwise, to recommend particular products or services.