September is National Cholesterol Education Month. High cholesterol is hardly news these days and the media, the medicine industry and the federal and provincial governments spend a great deal of time, energy and money into this education to arm ourselves in the war against heart disease. If lowering cholesterol were the only thing to do for heart disease then why are people still having heart attacks? There is much more to heart disease than cholesterol.

Cholesterol is a very important molecule in the body responsible also for the formation of hormones and immune factors and if the cholesterol reading is too low this poses health problems as well as having a reading that is too high.

The most informative lipid profile is one that contains a total cholesterol, HDL (high density lipoproteins), LDL (low density lipoprotein) and triglycerides all obtained from a fasting, no alcohol for 2 days, blood sample. HDL’s are the good cholesterol and the more you have of these the more protected the blood vessel is against the bad or proinflammatory LDL. Men usually have lower HDL’s than women but this may change for women as they become post menopausal and their heart disease rate catches up with those of men, because their HDL’s drop with age. Optimal HDL readings are greater than 1.5 and optimal LDL is less than 3.0 and triglycerides should be around 1.0. Taking the ratio of triglycerides to HDL cholesterol also gives a risk ratio for developing what we call Insulin Resistance or Metabolic Syndrome. More and more the medical community is realizing that insulin resistance often develops before heart disease. Insulin resistance is the body’s inability to recognize insulin effectively therefore not utilizing sugars which are then stored as fats such as found in obesity and high triglycerides. This mechanism is also found in diabetes.

The first clue might be an elevated triglyceride count so I will often counsel the patient to control the intake of sugars and simple carbohydrates and emphasize non starchy vegetables and good quality proteins. This alone is sufficient to lower LDL and raise HDL cholesterol in addition to lowering the triglycerides. Usually the patient is also prescribed Carlson’s purified cod liver oil to provide the much needed anti-inflammatory essential fats that not only lower LDL, raise HDL but also lower CRP (C-reactive protein).

CRP is an inflammatory marker that increases the risk of heart disease.  There are many other ways of lowering inflammation in the blood vessels including exercise and eating nutrients such as curcumin (found in curry dishes). I routinely check for ferritin (iron stores) as well because as men and women age their levels often increase and iron oxidizes or rusts in the body contributing to inflammation. The best way to lower ferritin is to donate blood 2-3 times per year, but check your levels first. I had a young man come to me with fatigue who turned out was anemic from too many blood donations!

Jane, age 48, had a total cholesterol close to 6.0 mmol/Lbut I quickly assured her that because her HDL was greater than 2.5 mmol/L this was partly to blame for the elevated total cholesterol which balanced out the LDL level that was a little over 3 but her ratio of total cholesterol to HDL was less than 3. I explained to Jane the importance of also doing the CRP and homocysteine tests to get a more complete picture of her cardiovascular risk. Her CRP was normal at 1.0 and her homocysteine was 5.5. These values indicate low risk for heart disease. (See www.DrPincott.com for a complete sample of my chemistry panel report).

Homocysteine is a normal metabolite produced by the amino acid methionine, that if found in levels greater than 6.0 increases the risk of heart disease, Alzheimer’s, diabetes and stroke among other diseases. It can be caused by a lack of vitamin B6, B12 and folic acid. Jane had been taking a B complex for years which was keeping her within normal limits. I have other patients who are not getting enough from their B complex, so we augment their treatment.

It is important to know your cholesterol numbers but also ask for CRP and homocysteine if you really want to see where you stand when it comes to heart disease risk!