If you are over 40 should you be on a Cholesterol medication?
In my experience in pharmacy, I have seen a trend over the last 30 years. Most people over the age of 40 are either being told to start a statin drug (i.e. Lipitor, Crestor, simvastatin, etc.), are already on a statin and are happy, or are on a statin and questioning whether there is a better way to treat their high cholesterol with fewer side effects. This is a touchy situation in the healthcare community. Doctors and pharmacists are taught that the lower the cholesterol the better. We are also taught disease state management, which tells us basically to wait until our patients are sick and then manage the disease. After many years I starting asking if this was the correct way to practice medicine.
Through some research, I found that the University of South Florida Medical School had an anti-aging and regenerative medicine platform. I qualified with my doctorate and attended a 2-year fellowship. Wow, what a concept wellness is. They taught me that we know diseases and how they progress, so why not PREVENT them?
Let me explain.
Our friend cholesterol is killing us, right? Actually many studies have proven that inflammation is causing the cholesterol to harm us. It has a lot to do with blood sugar “oxidizing” the bad cholesterol and other damage-causing inflammation that makes the cholesterol form the plaques. There was actually a study done by Diabetes Care done in the 1980s that proved that people with low cholesterol and slightly high blood sugar were many times more likely to have cardiac arrest than people with high cholesterol yet low blood sugar.
From the anti-aging perspective, I educate my patients to know their numbers. Most studies now are showing that fasting blood sugar should be less than 86, yet our medical system still says that a person is fine even with blood sugar levels as high as 100. What are all these statin drugs doing if cholesterol is not the lone enemy? They do lower CRP, which is a marker for inflammation. That is great, but we need to look at the whole picture. Even with these powerful cholesterol-lowering drugs in half the aged population, cardiovascular disease is still the number one killer. We need to assess inflammation to increase longevity and prevent disease. There are a lot of lifestyle changes that can easily be done on a daily basis to ensure each one of us has the best chance for a long and healthy life.
Why has cardiovascular disease increased over the last 60 years?
An answer could be that our lifestyles have changed drastically over the last 60 years. Let’s think about the evolution of people in the US over that last few decades. Our grandparents and great grandparents were raised in a pre-agricultural, hunter-gatherer situation. Now we live in a highly technologically advanced agricultural industry where machines do the work. We have gone from working the fields and expending all that energy to desk jobs. Our ancestors worked physically harder than we do today. Not only that, buy our diets have changed in the same time.
100 years ago going to the grocery store and buying some frozen pizzas and some Fruity Pebbles for the kiddos did not happen. We got up in the morning, milked the cows and grabbed some eggs from the coop. We had to hunt for food. This is significant because wild-caught animals are leaner and have no steroids, hormones, and antibiotics in them which cause inflammation. We also ate our fruits and vegetables that we grew in soil that has not been stripped of essential nutrients from lack of crop rotations. Think about all the exercise we had to go through just to eat! The EUR J Clin Nutr 1997; 51; 207-216 Paleolithic nutrition revisited Eaton et al., did a twelve-year study on diet. The conclusions were our dietary changes significantly increase nutritionally related diseases including hypertension, atherosclerosis, coronary artery disease, diabetes… The list goes on. Are you catching on here?
Can lifestyle changes work?
Absolutely! There are studies proving the effects of dietary changes and morbidity and mortality of coronary heart disease. N Eng J Med 1985;314:811-818 is a 20-year study on dietary changes and heart disease. Another huge study by JAMA 1998;280:2001-2007 by Ornish. et al. proved significant changes and reversal of coronary artery disease with intensive lifestyle change. In fact, the foundation for longevity should start with proper nutrition and exercise. The next step, in my opinion, is nutritional supplements and finally drug therapy.
Here is a simple list of nutritional guidelines from renowned cardiologist Dr. Mark Houston for getting heart healthy:
1. Mediterranean, NCEP, and Dash I and II diets are recommended
2. Reduce saturated fats to about 10% of total fat intake
3. Eliminate trans fat
4. Increase MUFA to 40% of total fat(olive oil, nuts, avocado etc.)
5. Increase PUFA (omega 3) to 50% percent of total fat
6. Increase viscous fiber to 50G/day
7. Increase vegetables to 6 servings per day
8. Increase fruits to 4 servings per day
9. Reduce refined (or eliminate) carbohydrates and use low glycemic foods. We want for complex carbohydrates.
10. Make sure your proteins are high quality with cold water fish and organic lean meat and poultry.
11. Maintain your ideal body weight and body composition
Somethings to keep in mind.
Understand that you cannot eat enough cold water fish to the 2000 to 3000 mg of omega 3 per day that I recommend to most of my patients. You can not get a physiological change that certain nutrients can provide by eating them. For example, if I wanted to increase your HDL cholesterol, you would need to be on 500mg to 1000mg of niacin. That would be 10 turkey breasts per day! There is a lot easier way and more cost effective ways to do this. I use medical grade supplements. Another talk altogether would be the unregulated world of vitamins and nutritional supplements. I think that the best case scenario is you just waste money.
I use the following when I have a patient whose cholesterol is out of whack:
1. Omega 3 Fatty Acids: (MonoPure ec by Xymogen) at 2000 to 5000mg per day
2. Niacin: 1000mg per day
3. Red Yeast Rice(RYR Synergy by Thorne) (high quality and standardized): up to 2400mg per night
4. CoQ10: (Max CoQ10) 50 to 100 mg
(I have all of the previous together in helpful packets. It is called Cardiac Essentials and I recommend 1 packet twice daily)
5. Curc u plex by Xymogen 500mg per day
6. Orthobiotic by Ortho Molecular 1 daily
7. PlantSterols by Ortho Molecular – 2 daily with food
8. Mixed Tocopherols by Ortho Molecular
Not all patients need everything listed.
It really is a patient-specific disease state that I can help with guidance. There are also really good studies on other products as well, ie, Bergamot, resveratrol, quercetin, NAC, garlic and so on. I am always reading and studying nutrition and ways to prevent disease naturally. I want everybody to understand that we have to make changes in the standard American diet and lifestyle for wellness to work. It is a concerted effort and no patients are ever alike.
Please consult a healthcare provider before starting regimens.
Feel free to contact us anytime.