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Tests and Procedures
In order to diagnosis and control high cholesterol you will need to have a regular blood test to measure your cholesterol levels. A blood test to check cholesterol levels typically measures:
- HDL cholesterol
- LDL cholesterol
- Total cholesterol
- Triglycerides
To measure cholesterol subtypes accurately, your doctor will most likely prescribe a lipid panel. This test requires that you avoid eating or drinking anything (other than water) for nine to 12 hours before your blood is drawn. After the test your doctor may ask you to schedule an office appointment to discuss the results, or if they are non-threatening may relay the test results over the phone. It is very important to discuss the results with your doctor fully and freely: so that you may fully understand their implications for your health. If managed properly through diet, exercise, and when necessary medication, high cholesterol need not negatively impact your overall health and wellness.
If your health care provider doesn't offer, you may want to ask for a Vertical Auto Profile more commnly known as a VAP tm test. While the total amount of cholesterol is important, the size of your lipid particles is as important. In general larger HDL and LDL particle size are associated with less risk of heart disease. This test is available through several national laboratories and frequently paid for by commercial insurance companies. (Additional tests that I routinely obtain in my patients as part of the assessment of their risk for blood vessel disease include: cardiac homocysteine; cardiac/high sensitivity C-reative protein and fibrinogen.)
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Generally, dietary and other lifestyle changes are the first steps to take if you need to lower your cholesterol. In addition, a number of nutritional and herbal remedies can help. Prescription drugs are also available; anyone taking a cholesterol-lowering drug should be monitored by a physician, who will check for adverse reactions and assess the drug's effectiveness. A good rule of thumb is to consider taking a prescription drug only if you can't lower your cholesterol sufficiently with self-treatment measures.
When treating high cholesterol it is important to be clear what your treatment goal is. Whether you use natural supplements, prescription medications or a combination to lower your cholesterol levels it is important to recognize that your individual goals may require an individualized treatment plan. Treatment goals may include any or all of the following: Lowering total cholesterol; lowering LDL cholesterol; raising HDL cholesterol; lowering triglycerides. With the addition of VAP tm cholesterol testing, treatment plans include: lowering the percentage of small lipid particles and raising the percentage of large lipid particles – be they LDL or HDL lipid particles.
Just a reminder: If you have a serious medical condition, it's always a good idea to talk to your doctor before beginning a program of supplements.
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Vitamins E and C, taken together or along with enteric-coated garlic capsules, are beneficial and safe--even if they are used over long periods along with a cholesterol-lowering prescription drug. Although vitamins E and C don't lower cholesterol levels directly, they help protect the body from "bad" cholesterol (LDL). Studies on garlic are only preliminarily promising, but many nutritionally oriented physicians suggest trying it (1, 2).
Inositol hexaniacinate, a form of the B vitamin niacin, will lower total and LDL levels, raise HDL levels, and lower triglycerides as well (3). As a result, this vitamin may prove more potent than conventional medicines in ultimately reducing the risk for a heart attack (and death from a heart attack). In a recent study of people with high cholesterol, niacin not only reduced LDL and triglycerides by 17% and 18%, respectively, but it also increased HDL by 16% (4). Although both nicotinic acid and inositol hexaniacinate have cholesterol-benefiting actions, inositol hexaniacinate is the preferred form--it doesn't cause skin flushing and poses much less risk of liver damage with long-term use.
Gugulipid, derived from a gummy tree resin, seems to break down "bad" cholesterol and perhaps even boost "good" cholesterol in animal models (5). Human trials of gugulipid have not met with the uniform success. Research results at best have been conflicting and can suggest only a modest efficacy of gugulipid for high cholesterol (6). A study published in the Journal of the American Medical Association (JAMA) failed to show a reduction in LDL after a 17 month intervention with gugulipid preparations (7). More research is needed to determine if gugulipid is effective for patients with high cholesterol and coronary artery disease (8).
Red yeast rice extract is a by-product of fermenting rice in a certain species of yeast. When taken as a supplement, it lowers cholesterol by precisely the same mechanism as a whole group of statin drugs (Mevacor, Pravachol, Lipitor, and others). These are all called HMG-CoA inhibitors because they inhibit the ability of the liver to synthesize cholesterol (9). Because red yeast rice acts like the statin drugs, the same precaution about monitoring your liver enzymes applies. The supplement should be discontinued if the enzymes rise excessively. In addition, like the statin drugs, Co Q 10 levels will be affected and supplementation with Co Q 10 is recommended.
Plant sterols and stanols prevent the absorption of dietary cholesterol through the intestine (10). Because they are not absorbed themselves, these substances pass harmlessly out of the body in the stool (11). Some studies have even shown that upping the amount of plant sterols and stanols in your diet can reduce LDL levels by 10 to 15% (12). Currently many margarine and butter substitute spreads are offered that are high in plant sterols and stanols. Look for these products in your grocery store to help prevent climbing cholesterol levels.
Policosanol is a natural product derived from sugar cane or beeswax. Several studies have shown that policosanol can effectively lower both total and LDL ("bad") cholesterol, while raising HDL ("good") cholesterol. Its action seems similar to that of the widely prescribed statin drugs and may even more as efficacious (13-15). In addition, as aspirin does, policosanol can block platelet aggregation or "stickiness" and thus may be useful in preventing both heart attacks and strokes and may be a useful adjunctive therapy against cardiovascular disease (16).
Pantethine, a form of pantothenic acid (vitamin B5), reduces the amount of cholesterol manufactured by the body (17). Pantethine is safe to use with cholesterol-lowering medications.
Psyllium, a water-soluble fiber from the husks of psyllium seeds, seems to lower cholesterol by binding substances called bile acids in the intestines. Bile acids are produced in the liver from cholesterol and needed for digestion. If there aren't enough bile acids, the liver will manufacture more, and recruit cholesterol circulating in the bloodstream in order to do so. A study on 68 patients administered psyllium in addition to conventional drug therapy found that the group that added psyllium to their diet could reduce the dosage of their medications while still lowering their LDL (18). Psyllium was also well tolerated, so if you are trying to lower your “bad†cholesterol you may want to ask you doctor about the possibility of adding psyllium to your treatment regimen.
Preliminary evidence also supports the use of copper to lower cholesterol and boost the body's antioxidant defenses (19, 20). Only small human trials and animal studies have been conducted thus far. More research will be necessary before these results can be confirmed in the population at large.
Artichoke leaf extract is also being exmianed as a possible therapy for high cholesterol. Initial studies show some beneficial effects, but no firm conclusions can be drawn due to small study size and limited length of intervention (21).
Get supplement dosages and tips in our WholeHealthMD Supplement Recommendations for High Cholesterol.
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· Cut down on fat and cholesterol. Try to reduce your intake of saturated fat and dietary cholesterol, both of which come chiefly from animal sources. Try to eliminate all trans fats from your diet. Also, limit your total fat intake to no more than 30% of your daily calories. Among the foods to avoid are beef, butter, and whole-milk dairy products, as well as coconut, palm, and hydrogenated oils (found in processed foods). Monounsaturated oils (olive or canola) are good substitutes for butter.
· Boost your fiber. Increasing the amount of high-fiber foods--fruits, vegetables, grains, and legumes--you eat will aid in cholesterol reduction (22, 23). A daily serving of oatmeal or oat bran may also make a noticeable difference.
· Substitute fish for red meat. Studies show that the oil found in tuna, salmon, and other varieties of cold-water fish, known as omega-3 fatty acids, can actually lower blood cholesterol. They can also be a helpful adjunctive treatment for conventional cholesterol lowering drugs in reducing triglycerides increasing good cholesterol (24). If you increase the level of omega 3's in your diet you may just be able to reach your cholesterol lowering goals and maintain your desired goals better than using statin therapy alone.
· Shed extra pounds. People who are more than 20% overweight should begin a weight-loss program to reach a healthy weight. This will greatly reduce your risk of cardiovascular disease as well as a host of other conditions including diabetes and some forms of cancer.
· Work out regularly. A program of regular, vigorous (aerobic) exercise, such as walking, running, or swimming, has been shown to increase levels of HDL ("good") cholesterol. Sometimes an exercise program is easier to stick to if you are part of a like-minded group. Walk or jog with friends during your lunch hour. Join a local gym. Take the stairs instead of the elevator. All of these simple changes can help you get the exercise you need in the regular course of the day.
· Enjoy alcohol--in moderation. Consider drinking one or two alcoholic beverages a day--but not more. Research indicates that moderate alcohol consumption can boost HDL. If you drink wine, opt for red over white; red wine is an excellent source of flavonoids called proanthocyanidins, which help prevent blocked arteries. If you are a non-drinker, however, you should not start drinking for its therapeutic effects. And you should definitely avoid alcohol if you have a current or past history of alcoholism.
· Stop smoking. Smoking not only increases total cholesterol and reduces HDL, but contributes to heart disease. Many employee assistance programs and health insurance companies now cover smoking cessation therapies. Check with your employer or insurance provider to see if they can help pick up the tab for you kicking the habit.
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Alternative Therapies
Acupuncture is an ancient technique in which a skilled practitioner inserts hair-thin needles into specific points on the body to prevent or treat illness. Numerous studies have shown, for example, that inserting needles into the skin stimulates nerves in the underlying muscles. This stimulation, researchers postulate, sends impulses up the spinal cord to a relatively primitive part of the brain known as the limbic system, as well as to the midbrain and the pituitary gland. Somehow that signaling leads to the release of endorphins and monoamines, chemicals that regulate chemical reactions throughout your body. Researchers believe that acupuncture may help to lower triglyceride and LDL levels in the body by increasing serum beta endorphin levels (25). Acupuncture may be used to regulate the stress response in your body which has been implicated in oxidizing arterial plaques into bad cholesterol.
Other therapies that have demonstrated promise in helping people cope with high cholesterol are meditative in nature. Programs in mind-body stress reduction (MBSR), meditation have been shown to be able to teach people how to handle stress thereby helping lower their cholesterol and other cardiovascular disease risks (26). Ask you physician for a referral to a mind-body skills instructor or behavioral health practitioner. Many insurance companies are now beginning to cover this type of training. Look for information at your local hospital of health clinic regarding the availability of these classes.
Ayurvedic medicine may help to lower blood cholesterol levels. These therapies seek to control the condition through diet, meditation and lifestyle modifications. Research has shown that the ayurvedic treatments such as guggul may benefit those with high cholesterol, however results have not been beneficial in all studies. You should discuss your decision to go see an ayurvedic therapist with your physician. He or she can then work with your chosen practitioner to design a health care regimen that combines the best of conventional and complimentary modalities. This