Retrospective #72: How to Fix Your Cholesterol

Physicians everywhere want to “fix” your “cholesterol.” They’re well meaning, and they know there is a very small benefit, probably due to a reduction in inflammation. But only if have known CVD, and you’re male and under age 65. They know that by lowering your Total Cholesterol (TC), your LDL will be lowered by the same amount. And they know they can do that with a pill. They can get your LDL to within the range recommended by the pharmaceutical industry’s “Standard of Practice” by prescribing a statin drug: Crestor or Lipitor or Zocor, or one of the popular generics like simvastatin. So, what’s wrong with that? The answer: it’s the wrong target!

In the first place, lowering LDL Cholesterol is by far the most common intervention for which your doctor can write a “script” (prescription). That’s why they do it. It must be frustrating for them though, since “high cholesterol” (meaning high Total Cholesterol and LDL) is almost always associated with low HDL and high triglycerides. They are all so common in the same patient. The result, however, is that sales of statins in the U.S. since they were introduced in the 1980s have skyrocketed. Meanwhile, HDL and triglyceride levels have remained unchanged.

It must be doubly frustrating that “high cholesterol” is commonly associated with hypertension (high blood pressure) and obesity. Collectively these are all among the indications of Metabolic Syndrome. See Retrospective #9 for specifics. The particular cholesterol markers associated with Metabolic Syndrome are low HDL and high triglycerides. The medical term for this cholesterol condition is “dyslipidemia,” or dysfunctional blood lipids (fats).

Although progress is being made in treating high triglycerides, unfortunately there is no pill to beneficially raise HDL. But dietary intervention works for both of these. See Retrospective #67 “HDL Cholesterol and the Very Low Carb Diet,” and Retrospective #68, “Triglycerides, Fish Oil and Sardines,” and then Retrospective #27, “…the strongest predictor of a heart attack” for the CVD benefits of dietary intervention for both triglycerides and HDL.

Of course, hypertension can be treated with medications, usually a “cocktail” of two or three. Obesity, however, stubbornly resists medical interventions. It is up to the patient, the doctors say, and the doctors usually report the patient is “non-compliant.” That is, the patient either cannot lose weight on the medically-recommended restricted-calorie BALANCED diet, or the patient who does lose weight soon gains it all back and often “then some.” Hunger wins out. The body, which can’t access its own fat reserves on a high-carb diet, doesn’t want to be starved. When it needs energy, it tells you to eat food-by-mouth for that energy, whenever your blood runs low on glucose.

So “high cholesterol” and hypertension, commonly seen together, are still the targets that most doctors treat together. The problem is: Total Cholesterol is an antiquated and almost useless term. It is only used because it can be easily measured and lowered by statins. HDL and triglycerides remain unchanged. But a Total Cholesterol that would be “too high,” because of its LDL component, would be perfectly okay with your doctor if the LDL was lower but the HDL was much higher and the triglycerides much lower. If that seems confusing, see Retrospective #25, “Understanding Your Lipid Panel,” for two identical Total Cholesterols with different HDL, LDL and TG components.

The reason for this is evident from the formula that was used for 30 years and until recently) for the lab cholesterol test: the Friedewald formula. In it, Total Cholesterol and HDL and triglycerides are assayed (actually measured), but the LDL value was calculated: LDL = TC – HDL – TG/5. A revised formula, Martin/Hopkins, used since Summer 2018, still also uses a calculated LDL, not a direct measurement. It does continue to assay HDL and triglycerides directly.

So, if the best way to “fix” your cholesterol is to raise your HDL and lower your triglycerides, you can do that – by following a restricted-calorie Very Low Carbohydrate diet. You will also lose weight easily and without hunger because your body will be free to burn your body fat. And you will get control of your blood sugar (if you need to), and lower your blood pressure. Your Type 2 diabetes (if you have it, or you’re pre-diabetic) will go into remission.

Your doctor can’t do these things by prescribing statins and blood pressure pills, but YOU CAN. But first you have to know about your cholesterol. Read Retrospectives #9, #25, #27 and #67 and #68 and take charge of your health.