The Basics of Cholesterol

One of the reasons I became a naturopathic physician is because I admired the naturopathic oath to treat each patient as an individual. I am often dismayed to see the depth to which modern medicine teaches practitioners to treat the disease and not the patient. Perhaps the best example of this phenomenon is high cholesterol. I regularly encounter patients who have been placed on a cholesterol lowering drug simply because a lab test indicated that their low density lipoproteins (more commonly referred to as LDL) were elevated. Like all health concerns, the decision to treat a patient with elevated cholesterol levels must be individualized and made based on numerous factors.

The basics must be addressed first. Certainly a proper history is necessary. Those who have had a stroke or heart attack, or those who have had close family members who have had one, have a greater chance of having a cardiac event themselves. This is an important consideration, and most physicians understand this point. Next, a patients’ exercise habits and menu should be assessed. Most readers of the Rogue Valley Messenger know that physical activity and good food choices are important, so I will not address them here.

It is worth considering consulting a doctor who is familiar with the most recent blood tests that address lipid metabolism. The tests that have been developed since the start of the new centaury have redefined how alternative minded physicians looks at lipid metabolism as it relates to cardiovascular health. These tests allow the physician to specifically identify the source of the lipid imbalance in the individual, and to develop a treatment plan unique to the patient that makes a simple metabolic course correction. For example, it is now possible to determine if lipid levels are elevated because of overproduction of cholesterol or because of overabsorption. In other words, we can answer the question: does the patients’ liver produce too much cholesterol or does the patient absorb too much cholesterol from their food? In the first case, nutritional and botanical medicines that support the liver and gall bladder may prove to be of benefit (e.g. phytosterols, methionine, red yeast rice, niacin and garlic); in the second case, fibrous nutrients that bind to cholesterol such as flax seed, acacia fiber and bentonite clay would be more appropriate. Physicians must also be literate about the battery of highly informative inflammatory markers (such as homocysteine, c-reactive protein, Apoprotein B, Apoprotein A-1, Hemoglobin A1c, lipoprotein(a), myeloperoxidase, sex hormones and adiponectin to name a few) in order to make a proper assessment of a patient with high cholesterol. Each of these markers is extremely influential in providing insights that allow the physician to individualize the treatment plan.

In the rare circumstances that the use of a cholesterol lowering medication is necessary, it is useful to know that some of these drugs are fat-soluble and some are water-soluble (just by knowing this fact, you probably know something most doctors do not). Some folks have a mild genetic inability to metabolize these fat soluble medications; if they are on this drug, they are more likely to suffer debilitating side effects such as brain fog and profound muscle pain. These folks may very well find that switching to a water soluble medication may make these side effects disappear.

In summary, I encourage patients who have concerns about their cardiovascular health to seek out a physician who is knowledgeable about nutrition, exercise, the use of up-to-date laboratory testing and most importantly, individualized medicine. It is the patient that must be treated, and never the symptom.