When "Good Cholesterol" Goes Bad
06/21/07; For years doctors have been telling you the importance of having healthy cholesterol levels, but today I’d like us to examine this more closely. And while I know that you’re a smart, informed health consumer, please allow me to start with a few basics:
Exactly what is cholesterol?
Cholesterol is a waxy, fat-like substance that is found in many foods, and of course, in our bloodstream, and in all of the cells of our body. In fact, you could not live without it. It’s important to the structure of your cells, for hormone production, and for converting vitamin D into a form your body can use.
While a lot of attention has been drawn to the dangerous effects of too much cholesterol, don’t be fooled into thinking that it’s a bad thing. Nothing could be further from the truth. Having a healthy amount of cholesterol in your body is key to overall good health.
Cholesterol is packaged in a special molecule called a lipoprotein that allows it to move throughout the body in your bloodstream. There are two main types of these lipoproteins, low-density (LDL) and high-density (HDL).
LDL transports cholesterol and triglycerides from the liver and small intestine to many different cells and tissues throughout your body, including the arteries of your heart. When LDL stays in your arteries for too long it can build up, become plaque, and block the flow of blood. If an artery that supplies blood to your heart or to your brain becomes blocked, the result can be a heart attack or stroke.
Drugs designed to lower LDL like Lipitor, Zocor, and Crestor, have been the drug industry’s biggest sellers for many years. According to an article in the April 2007 issue of Forbes Magazine, these three alone have generated over $200 billion in sales over the past decade.
HDL carries excess cholesterol out of the arteries and to the liver where it is further processed and disposed of. Most doctors will tell you that even if you can’t lower your LDL, you need to do all you can to raise your HDL level so that you reduce your risk of heart disease.
Not surprisingly, drug companies have invested a lot in trying to create new drugs to raise HDL. (After all, that would be another huge money-maker for that industry.) But so far, all the clinical trials for new HDL-raising drugs have been very disappointing. Results have been inconsistent and none of the research has resulted in a compound that even appears to merit further research.
So now you may be wondering�?Dr. Sinatra, what’s this got to do with me?" ...........
Good question. ......
When "good cholesterol" goes bad.
Our love affair with HDL is based upon scientifically proven facts. The well-respected Framingham Heart Study suggested several years ago that low HDL levels were the strongest predictor of heart disease. In fact, this study and other research have concluded that every one point rise in HDL decreases the risk of heart disease by 2%-4%.
But we’ve also seen examples where the correlation between HDL and the risk of heart disease were not as clean-cut.
For example, the Forbes article mentioned a team of Italian researchers who found a family whose HDL was very low due to a genetic mutation. Yet, this family had no trace of heart disease, apparently because the type of HDL they had was particularly beneficial.
Then there were some Japanese patients with a gene mutation that caused them to have very high HDL, yet it didn’t appear to be helping them at all.
These inconsistencies are troubling and most likely related to the fact that HDL is comprised of an ever-changing combination of cholesterol, protein, and lipids. Depending upon the make up of your individual HDL, it could help lower your risk of heart disease and stroke or it could have little benefit at all. {See Dr. Sinatra's web site for for a very shocking example:}
HDL has proven to be much more difficult to understand than LDL, and is still in many respects, a mystery.
Here’s what I want you to do now if you’re concerned about your HDL.
Ask your doctor for the VAP test. Short for "vertical auto profile," this test has the ability to break down the many individual components of cholesterol to single out the most dangerous fractions. As a result, you get a much more accurate picture of what may or may not be a cholesterol problem. I’ve written all about this test in the July issue of my newsletter, Heart, Health and Nutrition. ........
Take niacin (vitamin B3)
Niacin does a stellar job of naturally raising HDL. It also lowers triglycerides and a very dangerous cholesterol component, Lp(a), which we’ll talk more about in an upcoming e-letter. (Please stay tuned for this because managing them is critical to your cardiovascular health.) My colleague, Bob, raised his HDL from 48 to 62 after taking niacin for just three months!
When you take niacin, you’ll likely experience a tingly, pins-and-needles, sometimes hot, flushing of the skin. It usually begins on the forehead and works its way down your arms and chest. It can occur initially at doses as low as 50 mg a day and typically lasts no more than a half-hour to an hour, then disappears. The higher the initial dose, the greater the initial flush. Fortunately, you can minimize the intensity of the flush by taking the pills after meals.
I’ve found that flush is most intense when you first start taking niacin. As you continue, the intensity lessens and often within a week or two it vanishes. (This was Bob’s experience.) But if you stop taking niacin and then resume at a later date, you may experience a full flush again.
The reason you get a flush with niacin is the same reason it works so well in protecting your cardiovascular system. Niacin causes your capillaries to increase in size. When this happens near the surface of your skin, the area turns reddish and feels hot and tingly.
Over the years, I have had patients who became so alarmed that they ran to the emergency room, thinking that they were having a bad physical reaction to the nutrient. However, it is nothing to be concerned about.
Some people use the non-flush form of niacin because they are uncomfortable with the flushing effect. The problem with that is you don’t get the same good vascular benefits. Therefore, if you want reliable results, you should use the standard niacin, which is very inexpensive.
[Stephen Sinatra, M.D.]'s recommendation is that you start with 250 mg of niacin three times daily, and slowly work up to 1�? grams three times a day for HDL raising effect.
The over-the-counter brands I recommend include Slo-Niacin and TwinLab. Niaspan (500, 750, or 1,000 mg), which is available only by prescription, also works well. Ask your doctor about it (my colleague, Bob, takes Niaspan every day).
Please note: Niacin should be used with caution if you have diabetes. However, Niaspan in doses up to 750 mg is well-tolerated with minimal side effects (other than the flushing). Ask your doctor about it.
I hope you’ve found this information helpful and that you’ll refer to it as you continue down the path toward good health. Remember, through the pages of my newsletter, Heart, Health and Nutrition [http://doctorspreferred.com], ........ To Your Health,
Stephen Sinatra, M.D. P.S. Readers of my newsletter can rest assured that I’ll continue monitoring this important issue regarding HDL and will provide updates when they’re available. If you’re not currently subscribing, see [
http://doctorspreferred.com] to join us. Dr. Stephen Sinatra is a practicing cardiologist with an integrative approach to health and healing. [He] is also the author of the monthly newsletter, Heart, Health & Nutrition which includes his best advice on heart health, diet & nutrition, exercise, and much more.
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