LDL and Statins (Ukrainian radio show transcript)

Hello everyone,

Dr. Chuma here for another radio message.

I wanted to talk today about cholesterol and statin medications.

LDL, or Low Density Lipoprotein, is recognized as the principal driver of the development of atherosclerotic vascular disease. This leads to 3 of the top 4 leading causes of death in the US, #1, cardiovascular heart disease leading to heart attacks and heart failure, #2, cerebrovascular disease leading to strokes, and #4, dementia.

Although there are other concerning molecules like triglycerides and a molecule growing in awareness, Lp(a), LDL still predominates as the most significant.

Some internet influencers would have you believe that cholesterol and LDL are not a concern. But that is simply untrue.

Cholesterol is a waxy substance that plays essential roles in the body. Its functions include: 

• Cell Membrane Structure, especially in the brain.
• Hormone Production
• Bile Acid Synthesis, which helps to absorb fats and cholesterol in the intestines.
• Transport of Lipids or fats throughout the body.
• Brain and Nerve Function and
• Immune System Regulation.

There are various types of molecules which make up the cholesterol family. Best known are LDL, or low density lipoproteins, and HDL or high density lipoproteins. Although it is much more complex than this, LDL is dubbed the “bad” cholesterol, which, especially in the environment of inflammation, contributes to narrowed areas in arteries called plaques. HDL, the “good” cholesterol, can be thought of as a transport molecule which picks up LDL and transports it to the liver for removal.

Almost every cell in the body makes cholesterol, but the majority is made by the liver. The liver also has special receptors which bind and collect LDL particles pulling them out of circulation. The LDL then gets put into bile, an acidic fluid made by the liver, and is sent into the intestines where, hopefully, there is enough fiber to bind the cholesterol and poop it out. If cholesterol doesn’t get trapped by the fiber, it gets reabsorbed and gets re-made into LDL. The same happens to the cholesterol we consume.

Fiber is a type of carbohydrate, only found in plants, that cannot be digested by the human body. Fiber absorbs and removes not only fat and cholesterol, but various toxins as well. It also feeds the healthy bacteria in the gut which then produce beneficial compounds such as short chain fatty acids. Every plant has a unique form of fiber which is why eating a large variety of plants is so important for overall health. A whopping 98% of Americans do not get the daily recommended 20-30 grams of fiber, which is pretty low to begin with. Before the industrial revolution, most humans consumed over 100 grams a day! That is what people in the Blue Zones consume, and they are the healthiest and longest lived populations on Earth.

So dietary cholesterol does matter, however the saturated fat we consume is even more important because it reduces the number of LDL receptors in the liver, reducing its LDL clearing capacity.

Regular exercise, stress management, good sleep, and social support are important components of a heart-healthy lifestyle but most important is diet, focusing on a whole food, plant predominant diet, avoiding the 3 main contributors to elevated cholesterol: 

1. Saturated fat, which comes mostly from animals.
2. Cholesterol, which comes only from animals and
3. Trans fats. Although many companies have removed them from their products, they’re still present in many processed foods and meat and fish have naturally occurring trans fats. 

But diet and lifestyle alone will not do it for the 75% of Americans who are overweight or obese. Many would benefit from some additional help by taking medications and supplements.

Medications lower cholesterol levels in a few ways.

1. The most common drugs are statins which block cholesterol production in the liver by blocking an enzyme crucial for its creation. They also cause the liver to produce more LDL clearing receptors, and more cholesterol-transporting HDL. Examples include the most commonly prescribed drug worldwide Atorvastatin (Lipitor), Rosuvastatin (Crestor), and Lovastatin (Mevacor) which is also the main component of the herbal supplement Red Yeast Rice.
   
2. Some block cholesterol absorption in the gut. The main medication in this class is Zetia or ezetimibe. It works by targeting a cholesterol transporter protein on the surface of cells in the small intestine.
   
3. And then there are drugs which block the production or activity of PCSK9, a liver enzyme involved in the destruction of the LDL receptor. Inflammation, high fat diets, hypothyroidism and various chronic diseases lead to increased PCSK9 production.

Side effects include fatigue, muscle aches, liver function disruption and diabetes. These are often dose dependent and vary from statin to statin. Everything is about managing the risks and benefits. A statin may cause a slight bump in your liver enzymes or blood sugar, but if the trade off is a significant lowering of LDL and avoiding a heart attack or stroke, it may be worth it in the long run.

SUPPLEMENTS

There are 2 supplements which have shown some benefit with cholesterol levels.

The first is Red Rice Yeast. It is exactly what it sounds like, a form of Japanese rice which is fermented. During this process, the compound lovastatin is formed.

There are 2 problems with Red Rice Yeast. The supplement industry is very unregulated and measurable levels of lovastatin can vary 60x from brand to brand and even batch to batch. So you may buy a product which is completely useless. Secondly, there have been contamination problems with a toxic mold which can exceed safety levels by 65x.

Niacin, also called nicotinic acid, is a B vitamin, B3, that has long been used to lower triglycerides and to increase HDL. By increasing HDL, it indirectly lowers LDL. It also can affect liver function at higher doses but its main side effect is flushing, which can be minimized if it’s taken with food.

Other supplements which have been shown to be of benefit include:

1. Psyllium Husk, which is an easy, healthy source of fiber.
2. Plant sterols, which are plant sourced molecules similar to cholesterol, but compete with it for absorption. Plant sterols do not affect the body the same way animal derived cholesterol does.
3. Bergamot, a citrus plant from Calabria, Italy, which contains a compound shown to lower cholesterol.
4. Artichokes, which are very high in insoluble fiber, also contain some compounds which have been shown to lower LDL cholesterol and TG.
5. Barberries, which is where the supplement berberine comes from. This is used in managing diabetes but also helps to lower cholesterol.

The next step in lowering LDL and cholesterol naturally is consuming more of the foods which actively lower cholesterol:

1. Nuts and seeds have significant amounts of fiber and plant sterols.
2. Plant protein, particularly legumes. Beans are simply a superfood with tons of nutrients and fiber. All forms are great. 
3. Viscous fiber from such sources like oatmeal, eggplant, barley and ground flax seeds.
4. Plant sterols:
   1. nuts and seeds, particularly sesame seeds, pistachios
   2. whole grains like wheat germ and oatmeal
   3. vegetables and fruits like avocados, Brussels sprouts and broccoli
   4. oils like EVOO

Remember that even if you consumed no cholesterol or fat at all, you could still reabsorb too much cholesterol that the body produces if you are not flushing it out of the GI tract with fiber and plant sterols.

Do your heart, and the rest of your body a favor.

Eat well.

Exercise.

Manage your stress.

Sleep well,

Love more and

If needed, talk to your doctor about adding a statin. 

Just a reminder that flu is slowly on the rise. Don’t forget to get your flu shot.

Have a great weekend.

A great reference for some lifestyle approaches and other supplements to help with lowering LDL is Dr. Michael Greger’s book

“Lower LDL Cholesterol Naturally with Food: Simple Ways to Add Proven LDL Reducers to Your Everyday Routine”.

Cheap on Amazon.

See you next time.