Kristine L. Soly, M.D, F.A.C.C.

Holistic Cardiologist

Cholesterol and Triglyceride: What’s it all about?

Doctor Soly’s Articles

Cholesterol and triglyceride have such a bad reputation that the very words conjure up an image of blobs of fat (like those congealed on cold soup) lurking in the blood stream ready to attack the first available artery.  It’s so bad that people feel guilty or ashamed if their levels are elevated.  Articles regularly appear about cholesterol and triglyceride, as if it were something we all really understood.  But nothing could be further from the truth.

 

Not even physicians or scientists understand all we need to know about this complex issue.  New data is constantly emerging, resulting in changes in recommendations.  Hence the confusing (and often conflicting) advice from the medical community over the past decade that has left patients uncertain about what to do. 

 

Cholesterol and triglycerides are not bad substances.  They are natural and normal substances in the body and are essential components.  We could not survive without them. 

 

Cholesterol is not a fat.  It is a white, waxy substance which is soluble in fat (but not in water).  Each cell can synthesize its own cholesterol, which is used to regulate the rigidity of every cell membrane.  In addition, the liver manufactures about 3000 mg. of cholesterol every day which is used to produce the sex hormones (estrogen, progesterone, and testosterone) and adrenal hormones (aldosterone and cortisone), to make vitamin D and bile, to constantly assure proper cell repair throughout the body, and to serve as an antioxidant when vitamin and mineral stores are low.

 

Triglyceride is fat, and it also is not soluble in water.  Triglycerides are our main source of energy, and a layer of triglycerides make up the cell membranes of all of our cells, which enable them to function normally. 

 

Cholesterol and triglyceride are called lipids.  Though they are not necessarily bad for us, they get their bad reputation because of their association with saturated animal fats.  After consuming meat or dairy, lipids (triglyceride and cholesterol) are absorbed by the intestines and enter the blood stream.  From here they go to the liver and thence to the rest of the body. 

 

Since the blood is essentially water, and since triglyceride and cholesterol are not water soluble, they must be transported in the blood in carriers that can dissolve in water.  These carriers are called lipoproteins, which are made by the liver.  As their name suggests, lipoproteins are composed of lipids and proteins.  The lipids making up lipoproteins are mostly cholesterol and some triglyceride.  Hence, all lipoproteins contain cholesterol and triglyceride, even if they are not transporting them.  When your total cholesterol or triglyceride is measured, that number includes all that is contained in the lipoproteins--that which is part of the carrier as well as that which is being transported.

 

But since your blood is drawn 10-12 hours after your last meal, all the cholesterol and most the triglyceride you ate have been delivered to cells and are no longer in circulation.  But, the lipoprotein carriers are still in the blood stream, so the cholesterol and triglyceride that make up the lipoproteins are what is measured.   

 

Problems arise when there are too many lipoproteins in the blood stream.  This results when we eat too much saturated fat, so the liver has to make too many carriers to get it all delivered.  Some of the lipoprotein carriers in the blood stream then oxidize and damage the arterial wall so that plaque develops and produces atherosclerosis, which causes heart attacks, strokes, and other problems with arteries.  It is not the lipid (cholesterol or triglyceride) that causes the damage, but the oxidized lipoprotein.  Hence, lipid disorders are really lipoprotein disorders.

 

There are a number of lipoproteins in the body.  Chylomicrons transport cholesterol and triglyceride from the intestines to the liver, but only exist for a few minutes after eating so are usually not measured. Low-density lipoproteins (LDL) transport cholesterol from the liver to cells. Very low-density lipoproteins (VLDL) transport  triglyceride from the liver to the cells, after which they break down into LDL.  High-density lipoproteins (HDL) transport LDL from the blood stream back to the liver.  After all the cholesterol and triglyceride have been delivered, the primary lipoproteins left in the blood stream are LDL and HDL.

 

LDL cholesterol is called the “bad” cholesterol because it can oxidize and become involved in the formation of plaque in the arteries.  HDL cholesterol is called the “good” cholesterol because it takes LDL out of circulation and protects from the development of plaque.

 

While all of this may be confusing, it is not nearly the whole picture.  Recently it has been discovered that there is something called Lipoprotein(a), also called Lp(a), which is an LDL with an extra adhesive protein wrapped around it.  This is a “really bad” form of cholesterol that has a strong correlation with the formation of plaque.  Unfortunately, this lipoprotein is largely acquired by heredity, though lifestyle definitely plays a role.

 

To further complicate matters, we now know that LDL (the “bad” cholesterol) comes in more than one size (LDL Pattern).  There are large fluffy LDL’s (called Pattern A) which are thought to be more benign.  Then there are the small dense LDL’s (called Pattern B) which have a strong association with atherosclerosis.  So, not all LDL cholesterol is bad!  This might explain how someone might have high LDL without atherosclerosis (Pattern A) and someone else might have low LDL with very aggressive atherosclerosis (Pattern B).  Both heredity and lifestyle determine the LDL pattern.

 

Simply knowing your total cholesterol level does not provide enough information to decide whether you’re at risk for atherosclerosis.  At a minimum, you need to know your LDL and HDL levels.  Those who seem to be at higher risk for atherosclerosis may need to know Lp(a) and LDL pattern.  Additionally, it’s not just the cholesterol levels that you need to know--elevated triglyceride is a problem for atherosclerosis also.

 

It is desirable to have low levels of both cholesterol and triglyceride.  However, with cholesterol, it is best to have low levels of only the LDL-cholesterol and high levels of the HDL-cholesterol.  With LDL-cholesterol, it is best to have low levels of Pattern B and Lp(a). 

 

Most abnormal lipid levels are a result of poor lifestyle choices rather than heredity. Significant lifestyle changes and selected supplements can normalize nearly all of the lipid abnormalities.  In fact, for some of the conditions, only supplements (but not drugs) will work.  And, when adequate lifestyle changes and supplements are used together, only one or two people out of a thousand would need to utilize drugs at all.    

 

Diet should consist of whole foods (preferably organic) and be as close to vegetarian as possible (vegetarian + seafood is a very acceptable alternative).  LDL-cholesterol levels are mostly determined by the amount of saturated or trans fats eaten.  Triglyceride levels are mostly influenced by the amount of refined or high-glycemic carbohydrates eaten or alcohol consumed.

 

Some foods are really beneficial.  Diets rich in the following are particularly good for controlling lipids:

                 -soy products (e.g. tofu, tempeh, soy milk, etc., but not soy sauce)

                 -3-omega and/or monounsaturated oils (e.g.. seafood, flax, canola oil, olive oil, and nuts)

                 -soluble fiber (e.g. bran, guar gum, psyllium, flax, whole grains, beans, fruits, and vegetables)

                 -garlic and onions

 

Another lifestyle change that has significant impact on lipids is exercise.  Studies have shown that one hour of moderate exercise each day is sufficient to reduce plaque in the arteries.  Exercise not only lowers triglyceride and LDL-cholesterol, it is one of the few ways of increasing HDL-cholesterol.  Combining exercise and dietary changes is particularly beneficial because together they reduce obesity and lower lipids even further.

 

A number of supplements are effective in lowering lipids.  Niacin (a form of vitamin B3) is extraordinarily effective in this regard.  It not only lowers triglyceride and LDL-cholesterol, it increases HDL-cholesterol.  In addition, it is effective in converting the LDL pattern from B to A.  Finally, it is uniquely effective in lowering Lp(a), where drugs not only do not work, but even make it worse.  Niacin rarely causes some GI and liver problems, but has a very long track record of safety, something drugs do not have.  Niacinamide, also a form of B3, is not effective in lowering lipids.

 

Niacin is available in a number of forms.  The immediate-release form causes a very annoying flushing of the skin due to histamine release.  Many people refuse to take it because of this.  A sustained-release form, which largely eliminates the flush, has been available for some time, but is unfortunately associated with more liver abnormalities than the other forms.  There is an intermediate-release form (Niaspan) available as a prescription that usually doesn’t cause a great problem with flushing and seems to have less liver toxicity.  A different form of niacin, inositol hexaniacinate, has all the benefits of niacin without most of the disadvantages, and is a very safe method for managing lipids.

 

Many other supplements are effective in lowering lipids although in general they are less potent than niacin.  For example:  

Red rice yeast (naturally occurring Mevacor)

                 Policosinol (sugar cane wax)

Gugulipid (extract from the gugul tree in India)

                 Pantethine (a derivative of the vitamin pantethenic acid)

                 Phytosterol and phytostanol (plant alcohols)

                 Tocotrienol (form of vitamin E)

                 Citrus polymethoxylated flavones (Sytrinol = flavones + tocotrienols)

Coenzyme Q 10

                 Milk thistle (silymarin)

                 D-glucarate (calcium or potassium hydrogen)

 

Most of these supplements are best taken in pill or capsule form, although some can easily be obtained from food.  For example, the plant alcohols are easily incorporated into food.  Margarine is a good example of putting phytosterols and phytostanols into food.

 

The use of red rice yeast has been hotly debated in this country since it is a naturally occurring form of the drug lovastatin (Mevacor).  The FDA has been objecting to the sale of this supplement because of this (also because it cuts into the profits of a drug company).  However, some forms of red rice yeast are still available, and are very effective, but it must be remembered that this is a drug, even though it is in a natural form.

 

Beyond cholesterol and triglyceride, there are other non-lipid factors that are associated with heart disease.  In many cases, blood levels of these things should be checked. 

 

Homocysteine, an amino acid that results from the breakdown of protein, can accumulate in the blood stream and directly damage arteries so that plaque develops.  This is a very significant risk factor for coronary artery disease—one that many think may be more important than cholesterol.  This is a hereditary condition, but fortunately, taking additional folic acid, vitamin B12, and vitaminB6 will correct it.

 

Fibrinogen, a clotting factor, can cause blood clots to form in arteries if it is too high.  This also is usually hereditary, but can be corrected by taking Nattokinase, mixed carotenes (not just beta-carotene), and selenium.

 

Ferritin level is another potential risk factor.  This represents the amount of iron you have in the body.  Those with high levels are more likely to have heart attacks.  The solution is simple—donate blood regularly and don’t ever take iron supplements unless you have an iron-deficiency anemia (check your multi-vit since most of them have iron).

 

High sensitivity C-reactive Protein is a measurement of inflammation in the arteries.  If it is elevated, the risk of a heart attack is significantly increased.  Fortunately, things like fish oil, ginger, and curcumin (turmeric) can reduce this level.

 

Though these last 4 risk factors have nothing to do with lipids, they nevertheless should be considered, along with lipid measurements, Lp(a), and LDL pattern, in determining your risk for heart disease.  Be sure to ask your doctor to order them.

 

Whatever your situation, the bottom line is that lifestyle changes coupled with selected supplements can safely and effectively lower risk factors for heart disease in most people.  Rarely do drugs have to be used.  Of course it’s harder to alter lifestyle than it is to take a drug.  But think about this:  prescription medications (taken exactly as prescribed by the physician) are the 4th leading cause of death in this country, exceeded only by heart disease, cancer, and stroke.  Isn’t it worth the effort to change diet and exercise in order to avoid the risk of drugs?

 

 

 

 

 

 

 

 

 

 

 

 

By Kristine L. Soly, MD, FACC

LOWER BLOOD PRESSURE NATURALLY

 

By Kristine L. Soly, MD, FACC

About 60 million Americans, 1/4 of our population, have high blood pressure. Unfortunately, most people do not know they have it since it is a condition with few, if any, symptoms in its earlier stages.  However, it is a deadly condition and is often referred to as the “silent killer”.  It triples the risk of dying of a heart attack, and it increases the risk of having a stroke 7-fold.  Even if it does not cause a heart attack or a stroke, it dramatically increases the risk of premature death.  In fact, if it is uncontrolled, it always causes premature death or disability--no one escapes.

 

High blood pressure, or hypertension, creates disease by damaging the heart muscle itself and/or the blood vessels (both to the heart and to other organs).  This can result in:

-heart attack

-stroke

-other forms of coronary heart disease (e.g. angina)

-congestive heart failure

-abnormal heart rhythms (especially atrial fibrillation)

-kidney failure

-peripheral artery disease (atherosclerosis in the leg arteries which causes pain on walking)

-aneurysm of the aorta (bulging of the main artery from the heart which can lead to rupture and death)

-blindness (when the blood vessels to the eyes are affected).

 

If hypertension is ideally managed, these diseases do not develop.  Unfortunately, hypertension, when treated conventionally, is one of medicine’s most poorly controlled conditions.  Medications used to treat hypertension almost uniformly have significant side effects--two of the most bothersome are fatigue and sexual dysfunction.  Since patients with early hypertension do not feel sick, and since the medications have such significant side effects, most patients stop their medication(s).

 

To further complicate the issue, hypertension is not just a matter of high blood pressure.  Almost all patients with hypertension have the “Metabolic Syndrome”.  This is a hereditary condition where the cells are resistant to the effects of insulin so that very high levels of insulin are necessary to move blood sugar into the cells where it is stored as fat.  Not only does this cause a predilection to diabetes, but also the high levels of insulin prevent fat from being pulled out of the cells to be used for energy.  Failure to pull the fat out of the cells then causes obesity (especially in the abdominal area) and high blood lipids (cholesterol and/or triglycerides).  Also, high insulin levels affect kidney function which causes high blood pressure.  More unfortunately, obesity itself can create or worsen insulin resistance.  So it is clear that management of these patients will require more than just drugs to lower blood pressure.

 

Because neither physicians nor patients are regarding hypertension as the potential killer that it is, the American Heart Association has recently come out with a new classification of hypertension to emphasize the need to treat this condition early.  It has removed the category of “borderline” hypertension, where treatment was always considered to be optional.  Now “normal” blood pressure is less than 120/80.  Anything above that level needs to be treated.  But treatment should not necessarily mean “medication” or “drug”.  In fact, unless blood pressure is severely elevated, medications/drugs should not be the first therapy.  The American Heart Association has repeatedly emphasized to physicians and to patients that the first treatment for hypertension should be lifestyle changes.  Unfortunately, in a medical system where the average physician’s visit is only 6 minutes, adequate instructions for the lifestyle changes needed to correct hypertension, especially since Metabolic Syndrome is usually present, are almost never given.  What you do get are a few “hand-outs” and advice to “change your diet, exercise more, and learn to relax”.  Under these circumstances, it just won’t happen!

 

And yet, this is what needs to happen.  Except in the most severe forms of hypertension, almost all patients can be controlled without drugs.  A combination of lifestyle changes and well-selected natural supplements will be sufficient to normalize high blood pressure.  The lifestyle changes are significant, but my experience with patients (where I have spent the time to teach them how to eat, exercise, relax, develop intimate friends, and take a few selected supplements) is that they come to love their lifestyles and especially appreciate that the supplements do not have the annoying side-effects that drugs do.

 

The diet I teach is one of whole foods (preferably organic) which is as close to vegetarian as possible (vegetarian + seafood is good because fish oils lower blood pressure).  Salt restriction may or may not be important in the diet (only about 50% of hypertensives are salt sensitive and need to restrict salt) but alcohol must always be limited. Though 1 drink a day for women and 2 drinks a day for men are protective against coronary artery disease, more than this is dangerous and raises blood pressure.  Those who do not drink should not start.

 

The ratio of protein to carbohydrate to fat in the diet is very individualized and has to be worked out for each patient, depending on how his/her body metabolizes and what other conditions exist.  In general, patients with Metabolic Syndrome do not handle starches well because of the insulin resistance and do best to minimize starches (especially refined carbohydrates) in their diets.

 

I also help patients develop an exercise program according to his/her preferences and lifestyle.  Sixty minutes of regular brisk exercise every day is essential to keep blood pressure down.  Some of this should be weight-bearing to help develop more muscle and to strengthen bones, but serious weight lifting must be avoided.  For those who need to lose weight, 90 minutes of exercise each day is essential.  Once again, this is worked out on an individual basis.

 

Stress reduction is achieved by exposing patients to the various modalities of relaxation that are available.  What works for one will not necessarily work for another.  Some people love the peace and tranquility they achieve with the relaxation response or mindfulness meditation.  Others find that their minds are too “busy” to really learn these techniques, and they end up enjoying such things as tai chi, yoga, or visualization, and receive just as much benefit. It is important to find what works for each individual since it is something that will be done for the rest of his/her life and should provide immense satisfaction.

 

Helping a patient develop intimate friendships can be the most difficult part of the “prescription”.  But it has been shown repeatedly that people live longer, are healthier, and have lower blood pressures if they have a good social network of people where there is mutual caring.  Ours is not a society that encourages close relationships.  Extended families are rare, and most of us do not even know our neighbors.  Teaching patients to develop close relationships is a very slow process.  Sometimes it is necessary to start by having the patient get a pet--the love of a pet is unquestioned.  But then the dog has to be walked and, as a result, other dog owners are encountered and, as a result of this, people get to know each other and friendships are cautiously begun.  This is just an example.  It takes time, and it has to be individualized, but it’s a very important part of the process of lifestyle change, and it works!

 

Then there are supplements and certain foods that can help to lower blood pressure.  Everybody knows about the value of antioxidants, which have been shown to reduce the incidence of all forms of cardiovascular disease.  Vitamin C, mixed Vitamin E (not just alpha-tocopherol), mixed carotenoid vitamins (not just beta-carotene), and selenium are the ones that have been shown to be most effective.  Under any circumstances, even in those who do not have cardiovascular disease, it is wise to supplement to get adequate amounts of these antioxidants since even a good diet may not provide enough (especially vitamin E).

 

Foods that are particularly beneficial for lowering blood pressure include the omega-3 fatty acids and garlic.  These can both be obtained from the diet, but amounts of omega-3 (usually as fish oil) necessary to lower blood pressure cannot be obtained from diet alone.  If a healthy diet is being followed, substituting the “good” unsaturated fats (e.g. seafood, nuts, flax, canola oil, olive oil) for the “bad” saturated animal fats will lower both blood pressure and lipid levels.  Garlic is another food that is especially beneficial--it will lower blood pressure, lipid levels, and insulin resistance so it is ideal in those with Metabolic Syndrome.

 

Then, finally, there are supplements that you cannot realistically get from your diet, which can help lower blood pressure.  These include L-arginine (dilates blood vessels), L-taurine (balances sodium and potassium in muscle cells), magnesium (a natural calcium channel blocker without the side effects), fish protein powder from a Japanese bonito fish (a natural ACE inhibitor without the side effects), co-enzyme Q-10 (essential for cellular energy), and Hawthorne berry (dilates blood vessels). 

 

So, the bottom line is this--hypertension is a serious disorder of huge magnitude that is poorly managed by conventional medicine.  Left uncontrolled, as it usually is, it causes premature death or disability every time.  In addition, most hypertensives have the added complication of Metabolic Syndrome.  This condition is not going to be controlled using drugs alone.  But significant lifestyle changes with selected natural supplements can control almost all high blood pressure and Metabolic Syndrome without resorting to drugs.  The single most important factor in control of your blood pressure is the relationship you have with your physician.  Choose someone who cares for you and who will spend the time and energy to teach you what you need to know to cure yourself.