I remember when I was learning to defend against a knife attack in my blackbelt class. My instructor, a former special forces soldier, looked at us with a solemn look and said, “when defending against a knife attack, the question is not whether or not you will get cut, because you are going to get cut, the question is how serious will the wound be. Your job, in defending a knife attack, is to position yourself to limit the damage when you do get cut while disarming your attacker.” That wisdom can be applied to prescription medications as well.  As with any medication, the question isn’t whether or not side effects will occur, but do the reported benefits outweigh the numerous and almost certain risks associated with the drugs? Every day, medical doctors are forced to decide whether or not the risks of a medication are outweighed by the benefits, and how to dose and treat so that the risks of side effects are lowest while disarming the disease. Not exactly as dramatic as the knife attack, however, the outcome can be just as damaging and deadly if the wrong decision is made. The question at hand is, “are the risks of statin drugs outweighed by the benefits?”

A recent study sheds more light on the potential harm of popular cholesterol medications known as statin drugs. In this study on over 2 million men and women, researchers discovered that statin drugs significantly increased the risk of these serious side effects.
1. Moderate to severe liver damage
2. Moderate to severe muscle damage
3. Cataracts
4. Kidney damage

Do the benefits outweigh the risks?

That is what the PR firms keep telling us; but is it true? After crunching the numbers, the researchers found that you would have to treat 37 women and 33 men for five years to prevent one case of heart disease. They also discovered that stains prevent esophageal cancer; but you would have to treat 1266 women and 1082 men for five years to prevent one case.

So what about the potential side effects?

Scientists use a statistical calculation called “Number Needed to Harm” (NNH) to show risk. Let’s find out how many people will be harmed by statins in a five-year period.
1. One person will develop moderate to severe muscle damage for every 259 statin users
2. One person will develop moderate to severe liver damage for every 136 statin users
3. One person will develop kidney failure for every 434 statin users
4. One person will develop cataracts for every 33 statin users

Let’s use these numbers to figure out what we can expect per 10,000 patients who use statins for 5 years.
1. 271 fewer cases of diagnosed heart disease
2. 8 fewer cases of esophageal cancer
3. 74 cases of liver damage
4. 23 cases of kidney failure
5. 39 cases of debilitating muscle damage
6. 307 cases of cataracts

Doctors accept these risks because they assume that statins actually prevent heart disease, at best, they delay it, that is, for a few people. Based on this study, this means that 9721 out of 10,000 patients would gain no benefit from taking statins for five years. That is astoundingly dismal. Perhaps we should be looking for better options…

As you can see, this is a very important process and fibrinogen is an important player in keeping you from bleeding to death during injury.

So far so good, so why are we talking about fibrinogen?

Fibrinogen – The Jekyll and Hyde of the body

Fibrinogen apparently has a dark side as well. As with most compounds produced by the body, when they get out of balance they become potentially harmful and fibrinogen is no different. Because fibrinogen acts as a precursor to clots, you can imagine that if fibrinogen levels rise it can lead to abnormal clots such as deep vein thrombosis, heart attack and stroke. In addition, having a chronically elevated fibrinogen has been linked with plaque formation in the arteries and thus becomes a major risk factor in the development of heart disease. Fibrinogen can also impede normal blood blow by thickening the blood, thus making it difficult for oxygen and nutrients to be delivered to vital organs and muscles. This poor blood flow can cause fatigue, muscle pain and even memory loss.

You can see how an elevation in fibrinogen can lead to chronic health problems that ultimately decrease the quality of our lives. So what can be done about elevated fibrinogen?

How to Normalize Fibrinogen

First, have your doctor test your blood to determine if your fibrinogen levels are too high. Research suggests that fibrinogen levels should remain between 200 and 300 mg/dl, even though the blood test may list a much higher range as “normal”.

Now that we know that your fibrinogen levels are elevated, we recommend the following lifestyle and supplement change

1. Control blood sugar. Diabetics are at a much higher risk of heart attack and stroke. This increased risk occurs for many reasons, however, higher fibrinogens are likely one reason. Controlling blood sugar can have a significant impact on fibrinogen levels.
2. Exercise. Regular exercise can help to promote better blood flow while decreasing the amount of fibrinogen that is circulating through the system.
3. Adding olive oil to your diet has been shown to lower fibrinogen levels in people who have elevated levels.
4. Supplement with omega-3 fatty acids, specifically fish oil. The omega-3 fatty acids in fish oil have been shown to decrease the risk of heart attack. In addition, fish oil decreases triglycerides, stickiness of blood cells and…you guessed it, fibrinogen levels! For best results we recommend that you take enough fish oil to provide 1000 mg of EPA and DHA. A good recommendation would be WholeMega by New Chapter 2 capsules twice daily.
5. Normalize homocysteine. Homocysteine is a byproduct of protein metabolism that has been linked to heart disease. Your doctor can order a simple blood test to assess homocysteine levels. Elevated homocysteine prevents the body from breaking down fibrinogen and thus can lead to an increase in blood fibrinogen. If they are high then you will want to take supplements containing certain vitamins and nutrients such as B12, folic acid, B6 and trimethylglycine (TMG). One such product that combines all of these nutrients is called Homocysteine Factors by Pure Encapsulations.
6. Vitamin C can help to keep fibrinogen levels in check. It appears that you must take at least 2,000 mg of vitamin C daily in order to lower fibrinogen levels significantly. If you have high fibrinogen levels, you may want to take 1,000 mg of Pureway vitamin C from Your Prescription for Health, twice daily.

An important question to ask, however, is at what dose does something become a poison? We have discussed cholesterol in other articles…Today’s article is not about cholesterol, rather we are going to discuss cholesterol’s nasty little brother called triglyceride. Just as cholesterol plays an important role in the body, triglycerides also are important and necessary for survival. Triglycerides are your body’s way of transporting fat to the organs and tissues to be used for energy. Triglycerides are also stored in the body so that when energy is needed there is an abundant supply. Like cholesterol, the majority of triglycerides that are floating through the blood are produced by the liver. When your lifestyle is out of balance, the liver loses the ability to sense that the body no longer needs to produce triglycerides and these levels begin to rise in the blood stream. Once the triglycerides in the blood reach a level greater than 100 mg per deciliter then health begins to suffer.

A study that was published in the journal Circulation discovered that high triglycerides cause more damage to the blood vessels than having an elevated LDL (bad cholesterol). Another study that followed showed that patients with a high triglycerides level (over 200 mg per deciliter) had three times the risk of heart attack compared to patients with normal triglyceride levels. In that same study scientists found that people with the highest ratio of triglycerides to HDL cholesterol suffered a 16 time higher risk of heart attack compared to people with the lowest ratio of triglycerides to HDL. This ratio is calculated by dividing your triglyceride number by your HDL number, this ratio determines if you are suffering from a condition called metabolic syndrome. For more on this condition see the article on FirstLine therapy.

Metabolic syndrome occurs when the body produces too much insulin in response to a diet that is high in carbohydrates. This elevated insulin causes many problems for the body such as elevated cholesterol, triglycerides and blood pressure. Elevated triglycerides can also be a sign of an omega-3 fatty acid deficiency.

So what do you do if your triglyceride levels are elevated?

Occasionally, triglycerides are extremely high which can place the patient at risk of a painful and dangerous condition called pancreatitis. In these people, who can have triglycerides in excess of 1,000, medications are likely needed to prevent complications. With that said, medications are not the answer for 99% of the population. They simply cover up the real problem, which is poor diet and lack of exercise. The first step is to look at your diet. As with many other conditions and diseases, carbohydrates are the most common culprit. If your triglycerides are elevated it is likely that you are eating too many refined carbohydrates such as bread, pasta, cereal, sugars and sweets. Exercise is also very important because exercise burns excessive fat and sensitizes the body to insulin.

The next step is to optimize your omega-3 fatty acid intake. People who have elevated triglycerides can often drop their levels in half simply by adding omega-3 fatty acids from fish oil to their supplement program. It is important that you take enough fish oil to provide 1800 mg of EPA and 1200 mg of DHA per day. Recently, the FDA approved fish oil as a drug. This drug form of fish oil is ridiculously expensive and no better than the less expensive, non-prescription fish oils available. I will caution you to be very picky with your brand choice to assure that it is free of heavy metals and other contaminants. In our practice we use the Your Prescription for Health brand of fish oil for those who prefer capsules (3 capsules twice daily) or Carlson Labs Finest Fish Oil for those who prefer liquid (1 tablespoon daily).

It is my preference that you start with these two changes and give them a good 2-3 months before you retest. If after this period your triglycerides are still elevated above 100 then I would recommend that you try a special form of a B vitamin called pantethine. This is an effective tool for normalizing triglycerides and cholesterol. The recommended dosage is 450 mg two to three times daily. Niacin is also an effective tool against elevated triglycerides, however, given the possibility of severe side effects I would recommend that you reserve this as a last defense. To lower triglycerides, doses in excess of 2,000 mg may be necessary and regular blood tests to assess liver function will be needed on a fairly regular basis.

Although triglycerides appear to be an independent risk factor for premature heart disease, we must not lose sight that elevated triglycerides are an indicator of a more serious condition called insulin resistance or metabolic syndrome. IF you correct the insulin resistance, the triglycerides usually correct themselves. In addition, by correcting insulin resistance, you will also enjoy healthier cholesterol and blood pressure levels.

The incidence of heart failure is increasing dramatically in our society. So, to what can we attribute this rise? The conventional medical establishment attributes this to these main factors: increased survival fromheart attacks, advances in emergency medicine, and the fact that people are living longer, the presupposition being that heart failure is a natural condition that occurs with advancing age. Although, these factors may play a role, I think that they only scratch the surface of the underlined cause of heart failure.

What is heart failure?

Heart failure is a condition where the heart is not able to meet the needs of the organs of the body. There can be many causes of heart failure, however, it all amounts to an inability to circulate enough blood to feed the tissues of the body. This can result in organ failure, difficulty breathing, dizziness, fluid buildup in the lungs and ultimately death.

What really causes heart failure?

My father had had a heart attack many years prior to his heart failure diagnosis, at which time he was also diagnosed with diabetes. However, he had enjoyed many years of heart health and circulation appeared to be normal in the blood vessels of his heart. So, a good question to ask at the onset of any symptoms (which I would later learn in pharmacy school is a cardinal question in medicine) is “why now?” If his heart attack had happened many years prior and his heart circulation was good, why was he just now developing signs of heart failure. Here are 4 factors that I feel are significant causes of our near epidemic incidences of heart failure in our society. This list is by no means exhaustive, however, it should be sufficient for our discussion.

1. Medications. This is medicine’s dark little secret, yes, many medications can increase the risk of heart failure and are likely a significant cause of heart failure. These medications include, but are not limited to, statins and beta blockers. Statin medications are commonly prescribed to heart patients to lower cholesterol. As you will learn shortly, this class of medication inhibits the body’s ability to produce a “miracle nutrient” that ultimately prevents and treats heart failure. Stain medications include: Lipitor, Zocor, Crestor, Vytorin and any generic medication that ends in “statin”, such as lovastatin. Beta Blockers are a class of medication often used to treat elevated blood pressure, atrial fibrillation and other heart problems associated with a fast or irregular heart beat. This medication is commonly prescribed to people who have had a heart attack in order to improve the repair of the heart after the attack. Unfortunately, this medication is notorious for leading to congestive heart failure mainly due to its impact on the ability of heart to beat strongly. It has also been noted that this medication can inhibit the body’s ability to make the “miracle nutrient” that we will talk about shortly. Beta blockers include any medication whose generic name ends in “olol”, such as metoprolol. There are many other medications that can play a role in the development of heart failure so look each one of your medications up to determine if this is a potential side effect. The danger comes in medicine’s lack of acceptance that pharmaceuticals such as statins and beta blockers can be a cause heart failure.
2. Uncontrolled Elevated Blood Pressure – Although I am not a great fan of many medications used to treat elevated blood pressure, that does not mean that you do not have to pay attention to blood pressure. There comes a time when getting your blood pressure down is an important factor in maintaining health. When you want to build big muscles, you go to a gym and you lift weights which cause the muscle to grow larger in order to deal with the extra load that it has to work against. When blood pressure is elevated the heart must pump harder in order to circulate the blood to the organs. High blood pressure is like weights to the heart and the heart, being a muscle, responds to the elevated blood pressure by growing larger. You might think that this is a positive thing, however, many people end up with what is called a “boggy heart”. Much like a muscle bound bodybuilder, the muscles look big but they are not very functional. A boggy heart is no different, it looks big and strong but it is too big and bulky to efficiently push blood through the body. For natural alternatives to elevated blood pressure, see our protocol for hypertension. Hypertension should be treated and monitored by a qualified physician, especially if you are showing complications of the elevated blood pressure.
3. Dysfunctional Valves – If your heart’s valves are damaged, then the heart becomes less efficient at circulating blood. Valvular disorders require proper diagnosis and treatment, however, I will say that there has been some fascinating research showing that a deficiency of this “miracle nutrient” can result in valve damage. Supplementing with this nutrient can help to protect the heart and its valves.
4. Mitochondrial Deficiency and Dysfunction – The mitochondria play a critical role in energy production in the organs and cells of the body. The mitochondria are the powerhouse of the cell where the majority of energy is produced for our body. Without this vital structure we could not have survived as a species and if these structures do not work properly many different diseases can settle in and heart failure is one such condition. For many people who are diagnosed with heart failure, they are suffering from a mitochondrial deficiency and dysfunction that is at the heart of their condition. This is especially true when we cannot find a medical reason for the heart failure. There are many things that you can do to improve the mitochondria of your body.

The Discovery of the “Miracle Nutrient”

As I began investigating and searching for a natural solution to my father’s ailment I came across a small, paperback book called Coenzyme Q10 – The Miracle Nutrient written by Dr. Emile G. Bliznakov, president and scientific director of the Lupus Research Institute. Aside from the hokey title, I was pleased to see how well referenced and researched the information was. The book covered this critical nutrient in great detail, devoting a significant number of pages to heart failure, a hot area of research for this nutrient called Coenzyme Q10 (CoQ10 for short). There were many interesting findings presented in the book, here are a few highlights:

1. Researchers named CoQ10, “ubiquinone” when it was discovered because it was ubiquitous in the body, literally being found in virtually every cell.
2. When the body reaches a 25% deficiency, disease begins to settle in and when 75% deficiency occurs…you die. That is how important this nutrient is to the body.
3. Organs and cells that are most active have a tendency to require more coQ10 than other, less active, tissues. These highly active organs and cells are most susceptible to failure when the coQ10 levels begin to drop. These include the: heart, liver, immune system and kidneys.
4. People who have heart failure and valve disorders have a deficiency of CoQ10 in those tissues.
5. CoQ10 supplementation was an effective way to increase blood levels and more importantly to reverse heart failure and other conditions.
6. After the age of 50, supplementation may be necessary to maintain optimal levels of CoQ10.
7. Certain medications and condition may cause deficiency and treatment with CoQ10 can reverse this deficiency.

There were many other findings that were reported in the book, those are just a few. This book has since become outdated, the last version was published in 1995. Since then, there have been hundreds of studies published on CoQ10 that have added to our understanding of this powerful nutrient. Much of this research has led to more and more advanced forms of CoQ10 supplements which enhance the absorption and utilization of the fat soluble nutrient.

It was difficult to find CoQ10 supplements in the US at the time I read the book and when you found, it was quite expensive. Regardless, I hunted it down and after giving up food for a few days was able to afford a bottle for my Dad. He was skeptical at first, but after insisting he agreed to take it. He saw nearly immediate improvements. It is now 14 years later and he still takes his CoQ10 every day and both he and my dear mother attribute his survival and heart health to CoQ10 and that little book that still sits on my book shelf to this day.

Tonight I will, unfortunately, be attending a wake of the father of a friend of the family. It wasn’t until after his passing that I was informed that he had suffered with heart failure and ultimately passed due to complications of a failing heart. Although I realize that something always gets us in the end, I can’t help but feel a bit of outrage about someone who was taken before his time by such a condition as heart failure. Although, I can never be sure, I believe that had one of his doctors been familiar with and recommended some of the natural products that can help to improve the mitochondria of the heart, he may be alive today. Below I list some of these recommendations:

What to Do to Normalize a Failing Heart:

1. Ubiquinol – Ubiquinol is a newer, activated form of CoQ10 and may provide even more benefit than the standard CoQ10 (ubiquinone). The activated CoQ10 can go to work immediately to enhance energy production and energize the heart. It also has a tendency to absorb better and enter the mitochondria more readily resulting in high blood levels and improved results. Take 100 mg two to three times daily. (Higher doses may be used. If you are using standard CoQ10 (ubiquinone) then you will need to use higher doses 200 mg two to three times daily.
2. Mitochondrial Energy Optimizer – This formula contains a number of nutrients that are known to support the mitochondria and optimize their energy producing function. Included in the formula are Acetyl-l-carnitine to enhance the utilization of fat for energy, alpha-lipoic acid to protect the cell and the mitochondria from free-radical damage, Rhodiola to stimulate the production of energy in the mitochondria as well as other compounds to protect the cell and enhance energy production. Take 2 capsules twice daily.
3. Taurine – Taurine is an amino acid-like nutrient that helps to regulate and strengthen heart beat. Take 2,000 mg three times daily.
4. Corvalen (D-Ribose) – Ribose is a sugar compound used in the production of energy within the cell. This special sugar can help to increase the production of energy in the mitochondria and improve the strength of the heart. 5 grams twice daily.
5. Magnesium – Magnesium deficiency is common, especially in people with heart failure. Many medications are known to deplete the body’s magnesium and potassium and these medications such as water pills, are used by many with heart failure. We recommend magnesium aspartate 75 mg capsules 2 capsules twice daily.
6. Omega-3 fatty acids – There is no doubt that omega-3 fatty acids can work to protect the heart and enhance circulation. Although, omega-3 fatty acids have not specifically been studied in heart failure, by protecting the circulation and decreasing inflammation, this supplement will no doubt provide benefit. Recommended dosage: Carlson’s Finest Fish Oil 1 Tablespoon daily or Your Prescription for Health Super Omega-3 Fish Oil Capsules 3 Capsules twice daily.
7. Aerobic Exercise – Aerobic exercise has been shown to increase the number and size of mitochondria found in the cells of the heart and throughout the body. This is a crucial component of any comprehensive heart failure treatment plan. The key is to do only a little more than your body is used to at each exercise session. You want to make slow and consistant progress whenever you have been diagnosed with heart failure as it may be quite easy to overwhelm the heart. Talk to your cardiologist about supervised exercise programs that may be offered in your area. Do not underestimate the importance of aerobic exercise in strengthening your heart.

Most would list cholesterol as number one, at which time I would reply “you are not a listener of our radio program nor are you a regular reader of our newsletter.” If heart disease was compared to a recreational drug problem, cholesterol would be a drug mule (for those who are not up on your police lingo, a drug mule is a very low level person in a drug cartel who simply delivers the drugs). So if cholesterol is a low level drug mule, who would be the “king pin”?

Fat Blobs. That is right…fat blobs. Ok, if you prefer the medical jargon, they are technically called triglycerides. Triglycerides are basically little blobs of fat that float through our blood, in excess they are considered a major risk factor for heart disease by filling the LDL (bad cholesterol) with more junk to deliver to our blood vessels.

So what is too high?

Most lab reports will state that a triglyceride level of 150 mg/dl is considered acceptable. Our opinion, however, is “it depends”. It depends on your HDL cholesterol. You see, HDL (good cholesterol) is responsible for removing the junk from the LDL which decreases the amount of damage that LDL can do to the arteries.

So how low should your triglycerides be?

Triglycerides should never be any more than twice the HDL! According to nutritionist Byron Richards, author of the book “Mastering Leptin” and “The Leptin Diet”, when triglycerides exceed twice the HDL level then the stage is set for trouble in the blood vessels. But there is another problem…

Your blood test is wrong…

Well, not exactly. Here is the problem with the blood test. When your triglycerides are tested, they are usually tested after a fast. Triglycerides rise significantly after a meal. So testing during a fast is not the best way to determine how balanced your body is as it pertains to the production of triglycerides. But that doesn’t mean your fasting triglyceride level is not helpful.

If your triglycerides are elevated during a fast then you know that you have a problem. The problem is, we don’t know how big of a problem. Let us say a healthy person has a triglyceride level of 60 after a fast and 120 after a meal. Assuming that their HDL is in 60 range then we are in good shape. Now let’s say that there another, not-so-healthy, person who has an HDL of 40 and a fasting triglyceride of 160 mg/dl. It is certainly high but not terrible. But wait a minute…when we test the triglycerides after a meal it jumps to 475 mg/dl. Now we have a problem. Compared to people who have a non-fasting triglyceride level less than 89 our not-so-healthy friend has a 2.5 time higher risk of stroke.

So how do we get them down?

I am glad that you asked because a recent study took a look at all of the research published to date on the use of fish oil for lowering triglycerides. At the end of the study, they concluded the following:

1. Triglycerides were lowered an average of 7%
2. Fibrinogen decrease 10% (a risk factor for clotting and heart attack)
3. Platelet stickiness decreased 22%

Fish oil can be a very effective tool in lowering triglycerides. In this meta analysis, the researchers noted a modest but significant decrease in triglycerides through the use of fish oil. In our practice, we have found fish oil to be far more impactful for many people. It is not uncommon to see a 50% decrease in triglycerides in many people, especially people who have very high levels. With that said, it is important to note that elevated triglycerides is first and foremost an indication of insulin resistance and the most important factors in controlling triglycerides are decreasing refined carbohydrates (bread, pasta, cake, candy, etc.) and performing regular aerobic activity, such as walking, for at least 1 hour a day.

For more info please read our Health Protocol for Elevated Triglycerides.

Coenzyme Q10 is a vital nutrient produced by the body that plays a very important role in the formation of energy within the cell. It has been noted that the organs which require the most energy production, such as the heart, are most susceptible to becoming deficient in coenzyme Q10. Such a deficiency has been closely linked to the development and/or worsening of heart failure. Studies have also demonstrated improvement in heart failure patients who are supplemented with coenzyme Q10.
There is one big problem, however…
People who wait until the heart failure is at its worst level can’t seem to absorb enough coenzyme Q10 to energize the heart. One result of heart failure is a buildup of fluid in the body called edema and it is believed that a backup of fluid in the intestinal system decreases absorption of coenzyme Q10 and thus limits the usefulness of this nutrient in people who need it the most.
There is new hope…
A recent study evaluated the effect of two forms of coenzyme Q10 on patients diagnosed with the worst form of heart failure (class IV). First they gave the 7 patients an average dose of 450 mg of standard coQ10 called ubiquinone. Coenzyme Q10 blood levels only increased marginally which was insufficient to improve the ability of the heart to beat stronger. Then the researchers switched the patients to the newer form of coenzyme Q10 called ubiquinol. This form is believed to be better absorbed, retained and utilized by the body. The results were amazing! The coenzyme Q10 blood levels shot up to where we would expect significant clinical results, and that is exactly what we got. The heart ejection fraction, a measure of how much blood the heart is able to pump to the organs, nearly doubled from 22% to 39%! The researchers described the clinical improvements as “remarkable” as every one of the patients improved significantly decreasing in class from level IV to level II. All seven patients started out in the worst stage of heart failure and at least 6 out of 7 of the patients would not have been expected to survive the 12 month study, however, after 12 months 6 out of 7 patients were still alive and listed as “stable”. The one patient who died had stopped the new coQ10 after three months despite improvements in his heart function.
Although this study is very small, the results are significant enough for me to recommend the ubiquinol form of coenzyme Q10 for anybody who has been diagnosed with heart failure. The cost of this nutrient is higher than standard CoQ10, however, it is worth the expense if the difference is a working heart. Although this study used an average of 580 mg of ubiquinol, a smaller dose will likely suffice due to its increased bioavailability. I recommend that anybody who has been diagnosed with heart failure use between 200 and 300 mg of ubiquinol, more if your symptoms are more severe.
Shouldn’t everyone use the ubiquinol form?
If you are healthy, you can likely use the standard coenzyme Q10 (ubiquinone) supplement. If you have particular conditions that may require a more aggressive program then I recommend switching to the ubiquinol. If you don’t know which would be more appropriate for you, please feel free to drop me an email at drray@illnessisoptional.com.
(BioFactors. December 2008;32:119-128)

As mentioned earlier, there are two types of cholesterol. LDL, is called “lousy” cholesterol because it is the form that is found in the nasty plaques of the arteries. HDL is considered “happy” because it carries cholesterol from the tissues, such as the arteries, back to the liver where it can be disposed of. That is an oversimplified, albeit sufficient, description of the two main forms of cholesterol.

Once again, the goal with HDL is to achieve a higher level. When I was in pharmacy school, we were told that there were two main ways to impact HDL: exercise and moderate alcohol. I remember my professor jokingly saying “therefore, it would be in our patients’ best interest for them to run from bar to bar.” So for the remainder of this email I will discuss natural ways to increase your body’s own production of this important cholesterol particle. I will start with a discussion on specific lifestyle recommendations because these clearly have the most important and significant benefit to HDL levels and then I will conclude with a discussion of the supplements which act to top off our HDL levels.

Cut Carbohydrates! When we get a significant amount of carbohydrates in our diet, such as, bread, pasta, cake, candy and cereals, our body produces high levels of insulin. Elevated insulin triggers a condition called insulin resistance which has been shown to be a key factor in the development of cardiovascular disease. Part of the risk may be associated with the impact of insulin on the liver’s ability to produce HDL cholesterol particles. A low HDL is a classic presentation in people with insulin resistance and diabetes. By controlling carbohydrate intake you will have a positive impact on all lipids including HDL.
Exercise…LONGER. It is no secret that exercise has a positive impact on HDL cholesterol, however, until recently we didn’t have a clear idea as to how much of an increase could be expected. A Japanese study looked to answer this question. It was determined that the length of an aerobic exercise session was what determined the amount by which HDL would raise. In fact, for every 10 minutes above 20 minutes of aerobic exercise the subjects would enjoy a 1.4 mg/dl increase in HDL. Intensity and frequency were not nearly as important as the length of each exercise session. It is my recommendation that we each get 60 minutes of activity at least 5 days a week. I know it is a tall order, however, if people want extraordinary results in their lives they need to put in extraordinary effort.
It is Time to lose the weight. This one is cut and dried. Even small amounts of weight gain can have dramatic impacts on HDL cholesterol.
Good News for Smokers! The good news is…if you quit, you will enjoy a significant elevation in your HDL cholesterol.
Check Your Medications. Some medications can have a negative impact on HDL such as beta blockers and certain cholesterol lowering medications.
Oils can help. If you do use oils in cooking or salads use extra virgin olive oil as this has been linked to higher HDL cholesterol.
Your Chia Pet May Save Your Life. Chia seeds are a wonderful whole food and may help you achieve a higher HDL. Soluble fiber, found in chia seeds, has been shown to increase your HDL and help protect you from insulin resistance. In addition to the large amount of fiber found in chia seeds, they are also full of healthy HDL-raising fatty acids, nutrients and minerals. Try 1 tablespoon twice daily.
Fish Oil Increases HDL By Two Mechanisms – Omega-3 fats found in fish oil have many positive benefits to the body. One such benefit is increasing HDL cholesterol by increasing production while simultaneously decreasing the body’s dismantling of HDL cholesterol that has already been produced. We recommend 1 tablespoon daily of Carlson Labs or 6 capsules daily of Super Omega-3.
Niacin – No discussion of natural approaches to increasing HDL is complete without a discussion about B3, also known as niacin. Currently there are three main forms of niacin on the market: standard niacin, inositol hexanicotinate and niacinamide. Plain niacin is the form most commonly prescribed or recommended for cholesterol and it has very potent benefits to HDL and has also been shown to decrease heart attack risk and cardiovascular death. Unfortunately, niacin comes with side effects including uncomfortable rash/hot flash and potential liver damage (which occurs more often than I feel comfortable with). If you do use niacin, you should use a slow release and have your doctor test your liver on a regular basis. Inositol Hexanicotinate is a form of niacin that is bound to inositol. This form is believed to enter the blood where it is slowly releases the niacin to the body and may impact cholesterol. The cholesterol lowering benefits of inositol hexanicotinate (no-flush niacin) are inconsistent. It works well for some and is useless for many. There is no way to determine who no-flush niacin will work, for so it has fallen from favor with us. Those who use no-flush niacin with good result should continue, it appears to offer little risk to the liver. Niacinamide does nothing for cholesterol but can be a useful tool for those who suffer with inflammation.

Now I would like to shift directions a bit and move from a discussion of increasing the number of HDL particles that are floating through your blood to a discussion about how to improve the ability of your HDL to pull unwanted cholesterol from the plaques of the arteries. A very interesting study on genetically modified mice shed some light on how HDL works to inhibit plaque formation. HDL is not just a glob of cholesterol, it actually carries numerous enzymes which appear to offer much of the benefit. One such enzyme, called paraoxonase, appears to play a very important role in the blood vessels. When scientists genetically engineered mice to produce HDL cholesterol without this vital enzyme, the mice suffered significant inflammation within the blood vessels. This research suggests that HDL actually becomes harmful and inflammatory when it loses paraoxonase. In humans, acute stress such as surgery or trauma can cause the HDL to be depleted of this anti-inflammatory enzyme. Paraoxonase also appears to play an important role in detoxifying the LDL cholesterol, making it much less likely to deposit into the arteries. So what can we do to protect the paraoxonase and is there anything that can be done to increase the production of this powerful enzyme? The answer is yes! A Greek study evaluated vitamin E’s ability to protect the HDL cholesterol from losing its paraoxonase enzyme after intense exercise in 10 healthy basketball players. Initially the researchers tested the paraoxonase content of the basketball player’s HDL before and after intense exercise and found the enzyme levels plummeted after the exercise. They then began having the players supplement with vitamin E. After one month of supplementation with alpha tocopherol (vitamin E) the researchers tested the blood before and after intense exercise and found that the supplementation protected the HDL from losing the paraoxonase. This certainly does lend support to the protective effect of vitamin E for cardiovascular disease. If you do supplement with vitamin E, I recommend that you take a natural formula such as Unique E. 1 softgel (400 iu) daily should be plenty.

Recently, scientists have found that a class of compound found in many natural foods may actually activate your genes to produce more paraoxonase! This class of compound called polyphenols is found in many fruits, herbs and teas. Two specific polyphenols stand out in the research literature for their ability to increase the production of this enzyme: quercetin and resveratrol. These two products can be found in a formula called Resveratin by Xymogen. I recommend 1 capsule twice daily. This area of research is a very exciting one and may prove to me a much more important factor than the HDL number. We will continue to follow this issue and report on any new data that comes out.

One final note on cholesterol. As more and more research comes out we are seeing a change in the thought process of cholesterol and its impact on heart disease risk. The most recent literature suggests that the quantity of the cholesterol is far less important than the quality of the cholesterol produced. On your next doctor’s appointment, ask your doctor to order a blood test that assesses the quality of the cholesterol produced in addition to the quantity. This test is called the VAP test and it is available at most labs. If your doctor is not familiar with this test then it may be in your best interest to contact a holistic minded physician to follow this and other tests that may give you insight into your true risk of heart disease. To see a listing of these tests, please see the Heart Disease protocol in our Health Issues section.

The group with the lowest cholesterol were most likely to die during the study
HDL level (considered the good cholesterol) had no impact on risk of death
Women had higher levels of cholesterol than men and yet they lived longer!
Men who had similar total cholesterol and LDL cholesterol levels to the women lived just as long as the women
Even the bad cholesterol (LDL) was protective against early death. This means the people who had the most “bad” cholesterol lived the longest

Yes, but is there any other research that supports these findings?

Dr. Bernard Forette in Paris, France found that women of the mean age of 82 years of age who had the highest cholesterol enjoyed the longest lifespan. Women with a total cholesterol of 272 mg/dl seemed to have the longest lifespan while those women with a cholesterol of 155 mg/dl had over five times the risk of early death. When cholesterol was excessively high, in the range of 350 mg/dl, risk of death increased to 1.8 times normal. The interesting finding was that women who had cholesterols around 200 also shared an increased risk of dying equivalent to 1.8 times normal. The bottom line is there are two groups who die early, the group whose cholesterol is very low or very high! The group with an excessively elevated cholesterol usually have an inherited condition which causes extremely high cholesterol (around 400 mg/dl or higher), this group has a higher risk of early death.

In another study performed in the Netherlands, people older than 85 years of age were followed for 5 years. The group who had cholesterol levels greater than 252 mg/dl where half as likely to die as those with cholesterols less than 194 mg/dl. The people who had cholesterols between these two extremes enjoyed two-thirds the death rates as those who had the lowest cholesterol.

The bottom line of these studies is that senior citizens should reconsider cholesterol lowering treatment. Lowering cholesterol in seniors will not protect them from early death, it will likely shorten their lives. In addition, lowering cholesterol can place seniors at increased risk of depression, energy deficits and memory problems.

What about using natural products to lower cholesterol?

In senior citizens we do not recommend lowering cholesterol unless it is extremely high. At this point natural alternatives to cholesterol lowering medications can become a proper course of action. Unless cholesterol is elevated over 280, our recommendation is to leave it alone and look to other means of protecting yourself against heart disease. These other means include controlling carbohydrate intake, taking fish oil, antioxidants and other important herbs and nutrients to protect the heart.

References:

Schupf N, Costa R, Luchsinger J, et al. (2005). Relationship Between Plasma Lipids and All-Cause Mortality Nondemented Elderly. Journal of the American Geriatrics Society 53:219-226.

Forette B, Tortar D, Wolmark Y (1989). Cholesterol as a Risk Factor for Mortality in Elderly Women. Lancet 1:868-870.

Waverling-Rijnsberger WE, Blauw GJ, Lagaay AM, Knook DL, Meinders AE (1997). Total Cholesterol in the Oldest Old. Lancet 350:1119-1123.

In order to understand how the medical industry misleads you and your doctor into believing that these medications actually make a significant difference to your health, you will need to understand some very basic statistic terms. I realize that this may make you want to stop reading, but please continue, I promise that they are very easy to grasp and will only require 60 seconds of your time. Here they are:

Relative Risk (RR) – This is almost always the number that will be reported by the press and the drug companies because it makes the tiniest of difference sound quite impressive. Relative risk is best described by giving an example. If a study is looking to find out if a medication decreases the risk of death in a giving period and the results demonstrate that the medication decreased the death rate from 4 per 1000 to 2 per thousand then the Relative Risk reduction is 50%. It sounds quite impressive that a medication decreased the risk of death by 50%.
Absolute Risk (AR) – This number is the more meaningful of the two statistical numbers and will almost never be presented to the public unless they are discussing the side effect risk. An example of absolute risk reduction can be demonstrated by the above example. If the medication decreases the risk of death from 4 per 1000 patients to 2 per 1000 patients then the absolute risk reduction is a measly 0.2%. As you can see, this number is not as impressive as a 50% reduction.
Number Needed to Treat (NNT) – This value is an interesting representation of the data and can be quite useful in evaluating the significance of risk reduction. This value basically tells you how many people need to take the medication before one benefit is realized. If death is the endpoint, NNT means how many people you will need to give the medication to before one life is saved.
Now that you have a fundamental understanding of basic statistics, let us evaluate some of the research literature. Please note, we are not choosing obscure studies in order to prove our point, we are evaluating the very same studies presented by the drug companies and published in peer reviewed journals.

EXCEL Study – The EXCEL study used lovastatin and was a short duration of only 1 year. Unfortunately for the drug company, there was an increased relative risk of death of 150% and an absolute increased risk of 0.3%. This means that the lovastatin increased the risk of death. The NNT for this study was 333 which means that you had to treat 333 people to kill one person.
AFCAPS Study – Again lovastatin was the medication used in the study. This time the study continued for 5.2 years and again resulted in an increased risk of death, although lower than the previous study. RR was a 3.9% increased risk of death, 0.09% increased absolute risk and you would need to treat 5000 people with lovastatin to kill one person.
4S Study – This study used simvastatin and followed people for 5.4 years. At study’s end the subjects who took the simvastatin apparently enjoyed a 29% decreased relative risk. The absolute risk reduction was a miniscule 3.3% decrease which means you will need to treat 167 people in order to save one life.
HPS Study – This study used simvastatin and followed subjects for 5 years. At the study’s end the simvastatin group had a 12% relative risk reduction which translates to an absolute risk reduction of 1.8% which means you will have to treat 278 people in order to save one life.
WOSCOPS Study – This study used pravastatin and followed people for 4.4 years. In this study there was a 22% decreased relative risk reduction which amounted to less than a 1% absolute risk reduction. This means that you will need to treat 500 people in order to save one life.
PROSPER Study – This study used pravastatin for 3 years and had a relative risk reduction just under 2% which was an absolute reduction of just 0.2%. This means that in order to save 1 life 1429 people would need to be treated.
ASCOT Study – This study used medicines most powerful statin, atorvastatin. The relative risk reduction was just 12% after 3 years and the absolute risk reduction was just 0.15%. This means that you will have to give 667 people to save one life.

As you can see, it is in the advantage of the drug company to report the relative risk which is an inflated statistical value that is not the actual or absolute risk. When absolute risk is taken into account, the medication still appears to lower risk of death it is just a lot less than the relative risk would have you believe. In my book I am only interested in the absolute number of deaths, this way I can make a truly informed decision about my course of action. I am not interested in using a medication that only helps 1 in 300 people and subjects the remaining people to needless side effects such as liver damage, nerve damage, memory loss, muscle pain and increased cancer risk.

DHA, is the most “unsaturated” of the omega-3 fatty acid and has a great affinity for the brain and nervous system where it plays numerous roles. Research has shown DHA to be important for brain development in infants and much of the research has been devoted to how DHA supplementation improves brain development in the young. More and more data is now coming out that is shedding light on DHA’s roles in brain maintenance in adults. Some very interesting research has found DHA to be important in keeping the memory functioning properly as well as general brain function.

Two studies, the Chicago study and the Rotterdam study, reported a 60% decrease in incidence of Alzheimer’s in people who enjoyed at least one fish meal a week. These observational studies confirm previous preliminary research that found extremely low levels of DHA in the memory center of the brain of Alzheimer’s subjects who had succumbed to the disease. Research at the University of Kentucky found that certain phospholipids, which contain high levels of DHA, were severely depleted in the most diseased parts of the brain of Alzheimer’s patients.

Recent studies have found DHA to play integral roles in numerous important brain pathways including:
1. Maintaining adequate levels of important phospholipids that allow brain cells to communicate with one another
2. The proper production of certain neurotransmitters such as dopamine
3. The regulation of enzymes necessary for proper brain and memory function
4. The regulation of inflammation that can speed the process of Alzheimer’s and other diseases of the brain
5. The production of certain neuroprotective proteins which prevent damage to fragile areas of the brain through antioxidant and anti-inflammatory pathways. These protective molecules prevent the inappropriate death of nerve cells.
Aside from the benefits to memory DHA plays important roles in regulating mood. DHA deficiency has been noted in cases of depression and aggression. A recent study found dogs who are more aggressive may be suffering from a deficiency in DHA. In addition, a study performed in jails in England found a 50% drop in murder rates in jails when DHA was supplemented to the diets of the prison population.

Conclusion:

DHA, an omega-3 fatty acid found in fish oil, plays numerous roles in maintaining a healthy brain. I feel that fish oil is a vital supplement for people who want to protect their brains from degeneration and should be a first line prescription for those who have been diagnosed with any degenerative disease of the brain or mood disorder. There is evidence that krill oil, an oil extracted from a type of crustacean, may provide important phospholipids in addition to the omega-3 fatty acids. Although data is lacking that krill oil would be a sufficient replacement for fish oil, I feel that it would be a good supplement to add, along with fish oil, for people suffering with a brain disease.

Dosage recommendation: 1 Tablespoon daily of Carlson’s Finest Fish Oil (or 6-9 capsules daily if you prefer) could be used along with 2 capsules daily of krill oil.