Cholesterol Diet, Supplements and Home Cholesterol Tests: FAQ
Q: Is there any way I can influence some of the risk factors connected with high cholesterol?
A: There are some factors beyond our control (such as age, family medical history) and some we can influence. For example, there is nothing you can do if you are a 45-year-old man or a 55-year-old woman, or if your blood relatives experienced heart disease.
However, there are some things you can do:
- Lower cholesterol level
- Raise “good” cholesterol level (HDL)
- Quit smoking
- Keep your blood pressure under control
- Control diabetes
- Keep in good shape and stay active
People suffering from diabetes have a higher risk of developing heart disease. You need to lower cholesterol level to reduce this risk, but make sure you do that under your doctor’s supervision.
Q: Are there any cholesterol vitamins or supplements that will help me lower the level of bad cholesterol and raise HDL? I’ve heard there are some cholesterol lowering drugs that work.
A: If you have high levels of cholesterol, some natural products are available to deal with it. Some of them have endured hundreds or trials and proved to be 100% effective, while others have different effects on different people.
- Niacin and cholesterol. Niacin is a B vitamin that can be prescribed by your doctor. It has to be taken in big amounts and has an unpleasant side effect – flushing.
- Fish oil is known to reduce the amount of triglycerides – a form of bad cholesterol.
- Plant sterols reduce the amount of dietary cholesterol adsorbed in the intestine, lowering the total cholesterol level.
- Garlic may contribute to the lowering of cholesterol levels, although this hasn’t been confirmed in all of the trials.
If you are determined to fight the high level of blood cholesterol, natural and herbal products should be first discussed with your doctor. You need to learn about their possible interaction with the drugs you are already taking. Besides, pay attention to the list of ingredients as some products claiming to be natural may contain only chemicals.
Q: I’m 36 and have recently found out I have high levels of cholesterol. In general I have good health and am not overweight. So, should I get worried about it or not?
A: It’s hard to give one answer to that, as high cholesterol level is never good. At the same time, you are highly unlikely to get heart disease at your age just because of high levels of cholesterol. There are some factors that may contribute to it though, such as family history (whether your blood relatives had it), excessive weight, smoking and hypertension.
What you can do to make sure there is no risk at all is to keep to a special cholesterol diet aimed at lowering cholesterol levels. It includes eating low-cholesterol foods and exercising regularly but with moderation. From what you’ve described, you are most likely a low-risk patient and don’t need to take any medications. The cholesterol levels you should aim for are LDL less than 5 mmol/L and a total cholesterol to HDL ratio of less than 7 mmol/L; these numbers are based on the results of studies and provide for a healthier lifestyle.
However, without viewing your lipoprotein profile, we can’t give definite recommendations. You should talk to a doctor who will run all the necessary tests and tell you whether there is something to worry about.
Q: Do I have to take statins?
A: This entirely depends on the level of cholesterol you have and other risk factors that may contribute to the development of heart disease. High level of cholesterol is not the indication of anything, as your condition should be evaluated based on the combination of results of different tests; only then you can be prescribed cholesterol supplements or drugs.
Statins are not prescribed for every patient with high levels of cholesterol, as this is just one of the risk factors for heart disease or stroke. Before prescribing statins or any other cholesterol lowering drugs, your doctor will need to take into consideration a number of factors:
• Age
• General health
• Lifestyle
• Family medical history
• Blood pressure
• Excessive weight
• Diabetes
• Smoking
• Peripheral vascular disease
High cholesterol by itself is not an indication for prescribing a medication as it doesn’t mean you will develop these conditions unless accompanied by other risk factors.
If your doctor recommends taking a statin, it’s necessary to decide what dosage it is going to be. There are different doses available – from 5 to 80 milligrams, which depends on the kind of medication. The higher your LDL cholesterol is, the higher dosage you are likely to be prescribed. You should discuss with your doctor any possible side effects and drug interactions and how you can handle them before taking the medication.
Q: Are there any side effects related to the use of statins?
A: As most medications, statins have some common side effects, but these are likely to go away pretty soon as you get used to them. The most frequent side effects are:
• Muscle ache and joint ache
• Diarrhea of constipation
• Nausea
However, there are other side effects that are very dangerous, and although they do not occur in many people, you should be aware of them:
• Muscle problems. Sometimes statins cause muscle ache and their tenderness, the condition referred to as statin myopathy. The probability of experiencing muscle pains increase with the dosage of statin you are prescribed. In the most extreme cases, a protein called myoglobin is produced by the muscle cells, which can damage your kidneys and affect their normal function. You should also be careful with drug interaction, as some medications (antifungal medications, cyclosporine, gemfibrozil, erythromycin, nefazodone and niacin) increase the risk of rhabdomyolysis.
• Liver damage. In rare cases the use of statin contributes to the increase in liver enzymes. The increase is mild in most cases and doesn’t affect your health in any way, but if it’s dramatic, the first thing you need to do is to stop taking statin. This usually helps solve the problem. To control the number of liver enzymes you need to have them checked regularly, otherwise permanent liver damage is possible. Be careful with drug interaction, as some drugs (gemfibrozil and niacin) increase the risk of liver damage even more.
Taking into consideration both these side effects, you should be especially careful with statins if you have a history of kidney or liver disease. If you are taking any other drugs and are not sure about their interaction, ask your doctor or pharmacist.
Another important thing to consider is that if you start taking statin, you will be doing it for the rest of your life. So, before the treatment discuss with your doctor any other options available. Also, when you start taking the drug, pay attention to the way your body reacts to it, as some cases require dose adjustment and other modifications that can be made by both you and your doctor.
Q: Are home cholesterol test kits able to help me deal with my condition?
A: Unfortunately they are not. Home cholesterol test kits shouldn’t be used regularly to manage your cholesterol levels, as they are not consistent enough. Some of them can be used to measure the total cholesterol level, while others also measure HDL cholesterol levels.
It’s very important to know the level of your blood cholesterol, as it can contribute to the development of heart disease. However, home cholesterol test kits are not reliable enough, as even laboratory-based testing sometimes presents controversial results.
Besides, to manage your cholesterol you need to do a lot more than measure its level. Your condition should be assessed by professionals, and guidance should be provided based on the results. Home test will not provide you with sufficient information on whether you run the risk of cardiovascular disease.
Q: How can I raise my HDL if it’s too low?
A: It has been proved by several studies that the risk on developing coronary heart disease increases if the level of HDL cholesterol is lower than normal. However, as your HDL cholesterol level depends on your genes, it’s quite difficult to raise it, and the methods do not work equally well for everyone. It’s normal for men to have 40 mg/dL and for women – 50 mg/dL of HDL cholesterol.
The best way to raise the level of HDL cholesterol is to adjust your habits and change your lifestyle. Excessive weight, lack of exercise and an unhealthy full-of-cholesterol diet are the most common risk factors. You can also reduce the amount of alcohol consumed. For women after their menopause, estrogen treatment is recommended to slightly raise the level of HDL. However, all these measures need to be discussed with your physician, as long-term use of estrogen, for example, is thought to contribute to more frequent heart attacks, even though HDL levels increase.
There are also some drugs that proved to raise the level of HDL cholesterol in most patients. Quite often people with high LDL cholesterol level have to take a statin, while those with high amounts of triglycerides take fibrates (gemfibrizol or fenofibrate). Both these medications are known to raise HDL cholesterol level by 10%. However, the most efficient medications are niacin preparations, which normally raise HDL by 25%. The most commonly used brand name of this drug is Niaspan. It can sometimes be used along with a fibrate or a statin, if these two medications didn’t have any significant effect.
There is also a condition called isolated low HDL, characterized by low HDL cholesterol and normal levels of LDL cholesterol and triglycerides. When this condition is present, there is no single opinion among specialists on what method of treatment to choose, so the best thing you can do is talking to your doctor who, based on your individual reactions, will prescribe an efficient combination of drugs or recommend another method.
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