By Mark Hyman, MD
The singular focus on treating cholesterol as a means to prevent heart attacks is leading to the deaths of millions of people because the real underlying cause of the majority of heart disease is not being diagnosed or treated by most physicians.
For example, I recently saw a patient named Jim who had “normal” cholesterol levels yet was taking the most powerful statin on the market, Crestor. Despite this aggressive pharmaceutical treatment, this man was headed for a serious heart attack. Jim’s doctors had missed his real disease risks by focusing on and treating his cholesterol levels. All the while they were ignoring the most important condition that put him at dramatically higher risk of heart attacks, diabetes, cancer, and dementia. In a moment I will explain what this condition is and what you can do about it.
This craze for treating cholesterol has lead to an onslaught of pharmaceuticals designed to “lower cholesterol.” Statins are now the number one selling class of drugs in the nation and new cholesterol medications are produced every day. The latest in a new class of “super” cholesterol drugs, CETP inhibitors, now in the drug approval pipeline from Merck (anacetrapib) burst into the news recently with exclamations from typically restrained scientists. Data on this new drug was recently published in the New England Journal of Medicine and presented at the American Heart Association conference in Chicago.
The study found a 39.8 percent reduction in LDL (or bad cholesterol) and a 138 percent increase in HDL or good cholesterol.(i) Sure, the medications lowered cholesterol. However, the study was not large enough or long enough to answer the most important question: Did the drug results in fewer heart attacks and deaths? Despite this glaring omission, the scientists reporting on these results used words such as “spectacular”, “giddy”, “enormous”, “most excited in decades” to describe their enthusiasm over the medication. Of course, the researchers (as I described in a recent post “Dangerous Spin Doctors“) were on the payroll of Merck who funded the study.
Metabolic syndrome is the leading cause of heart disease, diabetes,
and a variety of other chronic illnesses in this country.
Why Lowering Cholesterol May Not Lower the
Risk of Death
Unfortunately, these scientists seemed to have short-term memory loss. Just three short years ago in 2007, another new “wonder” drug from Pfizer (torcetrapib) which worked on the same mechanism that anacetrapib does, was found to dramatically lower LDL and raise HDL cholesterol, just like this new drug from Merck. There was only one small problem– in those taking the drug, deaths from heart attacks increased 25 percent, deaths from heart disease increased 40 percent and overall deaths increased 200 percent.(ii)
After spending $800 million in development Pfizer had to walk away from the drug. Oops. How can a drug that does all the right things (dramatically lowering bad cholesterol and raise good cholesterol) actually cause MORE heart disease and deaths?
The answer is simple. Drugs don’t treat the underlying causes of chronic illness. It is not our genes which haven’t changed much in 20,000 years, although they may predispose us to environmental and lifestyle triggers of illness. The causes of chronic disease are rooted in what we eat, how much we move, how we face stress, how connected we are to our communities and toxic chemicals and metals in our environment.
A wry editorial in the New England Journal of Medicine many years ago remarked that doctors should use new drugs as soon as they come on the market before side effects develop. Perhaps that’s what the authors of this study are proposing we do with anacetrapib.
At best this new “super cholesterol” drug will lower cholesterol numbers without killing too many people while increasing health care costs by billions of dollars as millions of new prescriptions are written for this new “super cholesterol drug.” Worse it may end up in the same garbage dump Pfizer’s drug from 3 years ago did. Even worse scenarios exist… and the reason is startlingly simple…
These drugs do not address the fundamental underlying cause of heart disease. Heart disease is not a Lipitor or Crestor or even an “anacetrapib” deficiency. It is a complex end result of multiple factors driven by our diet, fitness level, stress and other lifestyle factors such as smoking, social connections, and, increasingly, environmental toxins.
Taking a pill won’t fix these problems that push our biology steadily along the trajectory of disease. The idea of putting statins at the checkout counter of McDonald’s is the epitome of reductionist thinking. The problem isn’t cholesterol— it’s all the stuff we are putting in our mouths!
Jim, my patient is a perfect example of how doctors treat the symptoms, not the cause of disease. As I have written about in a previous blog, most doctors focus on the wrong target for preventing and treating heart disease. Abnormal cholesterol levels are just a downstream problem that is mostly a result of “diabesity” or the continuum of blood sugar and insulin imbalances that range from pre-diabetes to full-blown end stage diabetes. Taking a statin or a CETP inhibitor cannot reverse this change in our biology. We cannot use a drug to correct what happens to our biology because of a high sugar and refined flour, low fiber, processed diet, a sedentary lifestyle, excessive stress, lack of sleep or the harmful effects of pollution.
Let’s take a closer look at Jim. On 10 mg of Crestor, the most powerful statin on the market, his total cholesterol was a beautiful 173, and his LDL was a respectable 101. But the good news ended there. His triglycerides were 176 (normal is less than 100), and his HDL was 37 (normal is greater than 50).
Jim’s number belie a deeper truth about cholesterol that most conventional doctors are ignoring today: Given the current state of scientific understanding, the cholesterol numbers doctors measure today are increasingly irrelevant.
The Real Cause of Heart Disease
Instead of looking just at the cholesterol numbers, we need to look at the cholesterol particle size.
The real question is: Do you have small or large HDL or LDL particles. Small, dense particles are more atherogenic (more likely to cause the plaque in the arteries that leads to heart attacks), than large buoyant, fluffy cholesterol particles. Small particles are associated with pre-diabetes (or metabolic syndrome) and diabetes and are caused by insulin resistance. Recent research (see my “Do Statins Cause Diabetes and Heart Disease” blog) indicates that statins may actually increase diabetes.
While measuring cholesterol particle size is a simple blood test that can be done at Labcorp, most doctors do not look at it, even though it is the only meaningful way to evaluate cholesterol numbers. You can have a LDL cholesterol that looks normal, like Jim did at 101, but you may have over 1000 small LDL particles which are very dangerous. On the other hand, you can have the same LDL number of 101, and it may be made up of only 400 large particles which cause no real health risk. Your health risk has less to do with your cholesterol numbers than it does the quantity and size of your cholesterol particles.
Again, we can take Jim as an example. His cholesterol particles were all small and dense because he had severe pre-diabetes. This is also not hard to diagnose. Jim was obese at 285 pounds with a BMI (body mass index) of 36. You are considered obese if your BMI is greater than 30. His waist-to-hip ratio was 1.04 (normal is less than 0.9 for men). He had very high insulin and blood sugar levels after we gave him a test drink of glucose (sugar). All this added up to tell us he had severe pre-diabetes or metabolic syndrome. As I mentioned before, he also had high triglycerides and low HDL– another clue that he had metabolic syndrome. We also found he had very low testosterone and growth hormone, further symptoms of pre-diabetes or metabolic syndrome.
Jim reported that despite working with a trainer he kept losing muscle and he was always hungry. This is why.
Let me reiterate: These are measurements and tests that can be done in any doctor’s office, but are rarely done. These are not esoteric or expensive labs that can only be done at specialty clinics.
The condition that Jim suffered from, metabolic syndrome, is the most common medical condition in America, but the most rarely diagnosed. It affects over half the population. It is the major cause of heart disease, diabetes, and aging, and it is one of the major causes of dementia and cancer, not to mention infertility and sexual dysfunction. Yet it is mostly ignored by doctors. Why? The answer is simple and tragic: There are no drugs to treat it effectively, and doctors tend to focus on what they can treat with medications, even if it is the wrong target. This is one of the reasons statins are so popular in America despite the vast research against them.
Eight Tips to Fix Your Cholesterol
(and Reverse Metabolic Syndrome without Medication)
Luckily, this doesn’t mean you are doomed, even if you are already suffering from metabolic syndrome and heart problems. High cholesterol and pre-diabetes or metabolic syndrome can be successfully diagnosed and treated. I have reviewed this in previous blogs but here are 8 tips to help you get big large fluffy cholesterol particles and reverse metabolic syndrome.
- Get the right cholesterol tests. Check NMR particle sizes for cholesterol by asking your doctor for this test at Labcorp or LipoScience. You want to know if you have safe light and fluffy cholesterol particles, or small dense, artery damaging cholesterol particles. A regular cholesterol test won’t tell you this.
- Check for metabolic syndrome.
- Do you have a fat belly? Measure your waist at the belly button and your hips at the widest point– if your waist/hip is greater than 0.8 if you are a woman or 0.9 if you are man, then you have a problem
- If you have small LDL and HDL particles, you have metabolic syndrome.
- If your triglycerides are greater than 100 and your HDL is less than 50, or the ratio of triglycerides to HDL is greater than 4, then you have metabolic syndrome.
- Do a glucose insulin challenge test. This is very important and most physicians do not test for insulin and glucose. To read more about how to do the right type of testing for metabolic syndrome or pre-diabetes please see The Diabesity Prescription for my information.
- Check your hemoglobin A1c, which measures blood sugar over the last 6 weeks. If it is greater than 5.5, you may have metabolic syndrome
- Eat a healthy diet. Eat a diet with a low glycemic load, high in fiber, and phytonutrient and omega-3 rich. It should be plant based, and you should consume plenty of good quality protein such as beans, nuts, seeds, and lean animal protein (ideally organic or grass fed). I have described specific diets that abide by these parameters in my books UltraMetabolism and The Diabesity Prescription.
- Exercise. Enough said.
- Get good quality sleep. Sleep is essential for healing your body, maintaining balanced blood sugar, and your overall health.
- Use supplements to support healthy cholesterol particle size. These include:
- A multivitamin including at least 500 mcg of chromium, 2 mg of biotin and 400 mg of lipoic acid. For most you will take 3 capsules twice a day.
- 1000 mg of omega-3 fats (EPA/DHA) twice a day.
- 2000 IU of vitamin D3 2000 a day.
- 1200 mg of red rice yeast twice a day.
- 2-4 capsules of glucomannan 15 minutes before meals with a glass of water.
- Broad-range, balanced concentration of plant sterols. You will usually take 1 capsule with each meal.
- Consider using high dose niacin or vitamin B3. This can only be done with a doctor’s prescription. It is useful to help raise HDL cholesterol, lower LDL cholesterol and triglycerides, and increase particle size.
- Use low-dose statins ONLY if you have had heart disease or are a male with multiple risk factors, while carefully monitoring for muscle and liver damage.
For the vast majority of people this approach is better than simply taking a cholesterol medication. To reduce your risk of heart disease you need to address metabolic syndrome, and that can ONLY be done effectively with a comprehensive diet and lifestyle approach like the one outlined above.
Now I’d like to hear from you … Have you taken statins, what has been the effect and do you have muscle pain or any neurologic side effects?
Do you think metabolic syndrome is an important factor to address to reduce the risk of heart disease? Why or why not? Has your doctor ever said, your sugar is a little high and we will watch it? Watch for what– until it is so bad you are eligible to take diabetes medication?
What do you think of conventional medicine’s tendency to prescribe medications over dietary and lifestyle change for chronic health conditions?
I would love to hear your thoughts. Share them by leaving a comment below.
To your good health,
Japanese Secret for a Healthy Heart
(i) Cannon, C.P., Shah, S., Dansky, H.M. et al. 2010. Safety of anacetrapib in patients with or at high risk for coronary heart disease. N Engl J Med. 363(25): 2406—2415.
(ii) Barter, P.J., Caulfield, M., Eriksson, M. et al. 2007. Effects of torcetrapib in patients at high risk for coronary events. N Engl J Med. 357(21):2109-2122.ol,
Written By: Updated: February 11,2011
8 thoughts on “8 Tips to Fix Your Cholesterol Without Medication”
This is the best article on the importanc of a healthy
lifestyle that I have read.
I am 76 years young, take no medication, have no pain
relievers in my home, have no aches and pains, do regular exercise, eat a healthy well-balanced diet, and enjoy every day to the fullest.
I drink 600ml filtered water when I wake up, each day.
Thanks for a great read.
I just read your blog. I was very intrigued. My cholesterol lab work was as follows: Total 221. HDL: 74, Triglycerides: 161, LDL: 115. Chol/HDLC ratio 3.0. When I went to see my doctor after my lab work came back, he verbally said that my LDL was 161. If you notice that it was my Triglycerides that were 161 not my LDL. He didn’t bother to take a better look. He quickly prescribed Zoccar. I told him I was afraid to take it due to the side effects. Mainly, the muscle pain. I suffer from back problems and sciatica. How would I know if I was having pain from my sciatica or the Zoccar? Something didn’t seem right when he told me my LDL was 161. So I went back to his office the next day and got a copy of my lab work. The nurse who handed me the copy said: “Do you have any questions or concerns?” I replied: “Yes, my LDLs are high and I’m afraid to take the Zoccar.” She responded: “I don’t blame you.” I asked if I could try changing my diet and doing some exercise. She said OK. Gave me a diet guide and sent me on my way. When I looked at my copy of the lab work, I was shocked to see that it was my Triglycerides at 161 not my LDLs. I have a brother who is a registered Dietician with the state of California. I read him my report and told him that my doctor wanted me to start taking Zoccar. He said: “You don’t need to take that” Change your diet and start exercising. So, I changed my diet and exercise at least 1/2 hour everyday. I also do stretching and yoga for my back. In one month, I have lost 20 lbs! I feel so much better! I still need to get my lab work again to see if my numbers have changed. Doing exercise and eating better has completely changed my life! I’m glad I listened to my brother and not my doctor. Looks like it’s time to get a new doctor.
Good, there seems increasing [overwhelming to some, but we’re talking attitude change here, never easy!] that statins are not only NOT the answer to lifestyle changes, but actually dangerous. But how to persuade the huge lobbying power of the pharmaceutical companies?
The NHS in UK is the same – the change that is needed is towards health rather than treating illness – still I see patients who say that they don’t want to know about their condition, just want a cure [meaning ‘magic pill’]. Almost never the answer!
But, we are still dominated by Western Medicine approaches, and to blame for the mess our health services are in.
One thing that would be helpful – to quote levels in SI units as well, please! But generally, great information – keep it coming!
Regards – Ross
I will only go to a mainstream physician if I am forced to. I just went to get my DOT physical and the Dr. told me that I needed to at least take an aspirin every day to prevent a heart attack. I’m 56. He informed me that he takes daily aspirin and there is nothing wrong with him. I let him know that I understood his dilemma of not having enough time to read up on the research on how harmful aspirin is to the body, but that he might want to consider doing that for his own health, if not for his patients. Needless to say, I didn’t win a new friend that day. They are simply too busy to keep up with what it’s really all about. To be sure, those Dr.s are the ones dispensing voodoo medicine, not the NMDs.
Thank you so much for this article. It confirms so much of how I feel about my husbands muscle aches. My husband had a heart attack in July of 2007 and was immediately started on Lipitor, Plavix, Coreg, and Altace. He continues to take all four medications. I have watched him suffer now for a very long time with muscle aches. He moans often and I will ask what is wrong and he says, “I hurt all over, my muscles ache.” I follow Dr. Mercola and other websites, including this one, that I feel are not afraid to speak the truth. I knew after reading about Coenzyme Q10 that he was probably suffering from this being depleted. The nurse practitioner never seems to care about his muscle aches. She usually just does not address that we even mention it. I asked her specifically about it, and she finally admitted it can be depleted and to take 200mgs a day if you want to. I cannot convince him to do it. Some people are so indoctrinated to what a doctor says that any other advice just doesn’t hold the same level of trust.
As for me, I am scared to death to have the test thinking I might indeed find out I have the metabolic condition. I’m scheduled for complete physical next week and will gather my courage and ask for what I need to find out. I am 62, in good health, low weight. Usually exercise on a regular basis (too hot this summer). I have had high cholesterol for years. Total runs around 232, LDL 138. When I exercise my HDL does rise to around 60. When I do not it does drop below 50. My triglycerides are under 100. I try to eat well, but truthfully I need to change my diet habits. I think the worst thing I do is have a Dr. Pepper (regular not diet) usually every day in the afternoon.
Thank you so much for this information. I am going to share it with all my children and many others.
GOD Bless You, Your Family, and Your Work!
This is great stuff. I’m now working on my cholesterol.
I’m now a vegetarian, eating mostly fruits, vegetables, nuts and grains. Exercise 5 days a week. Hope this will work for me.
You are engaged in a wonderful ministry. God bless
Any recommendations on brands of multiple vitamin
I am a60 years old woman with a long history of myofascial pain syndrome and fibromyalgia. I also have metabolic problems going back 20 years or more, including hypertension, hypothyroidism, high total and LDL cholesterol (the small dense kind) high triglycerides,low HDL. My insulin and glucose levels were checked years ago and the insulin levels were found to be sky-high. It’s a sign of the times that I was treated with metformin, fen-phen, and exercise.I did lose some weight. Years ago I was put on Lipitor, which lowered my cholesterol, but didn’t raise my HDL or change any of the other metabolic factors. I’m also on Atenolol high BP and Armour thyroid for hypothyroidism. I have had extremely bad peripheral neuropathy for years, for which I take Neurontin. Eight years ago, a very enlightened doctor who was investigating my severe magnesium (cause never found, requires large doses of oral and IM Mg) told me to stop taking Lipitor, because its side effects were the same as my symptoms (muscle pain,neuropathy, cognitive problems) .I tried various herbal remedies which did not lower my cholesterol significantly. A few years ago, my integrative medicine physician convinced me to go back on a statin. I started Pravachol at a very low dose, which had to be increased several times to lower my cholesterol. I didn’t think I had any side effects. However…
I was listening to a talk by Dr. Hyman detailing all the problems that statins could cause. I was familiar with the list, until he mentioned “tendon issues.” My ears perked up, as I had somehow managed to tear 4 tendons in my left shoulder after minimal activity which was not sufficient to cause such an injury. I Googled statins and tendon injury and was shocked to discover a 2005 French study, which identified 96 patients with tendonitis and tendon rupture believed due to statins. I recalled that the year before I tore the tendons, I had severe tendinitis in both elbows that lasted a year, despite treatment by a physiatrist. And several years before that, I tore two tendons in my other shoulder. I immediately stopped the statin. My integrative med doctor understood, and is working with me to lower my cholesterol by other means.My family doctor told me flat out that she did not believe statins had anything to do with my tendon injuries, and strongly recommended that I resume taking it. I told her that I although the connection couldn’t be proven,I wasn’t willing to risk any further tendon tears. I realize I have to get my metabolic syndrome under control (I’m taking most of the supplements mentioned above plus a bunch of others), but I do not have bona fide cardiac disease and I don’t believe a statin is necessary. I want to thank Dr. Hyman for bringing the issue of tendon tears associated with statins to my attention. They are listed as a side effect of statins in France, but not in this country.