A: Your neighbor was either prescribed Simvastatin because of high cholesterol levels or because of her history of a cardiovascular disorder. Generally speaking, this and other drugs in the same class of meds work well by blocking a substance the body needs to produce cholesterol. Statins may further help the body reabsorb cholesterol’s build up of plaque in arterial walls. There are a number of statins. Some are generic equivalents and more reasonable to purchase but essentially perform the same function. When prescribed because of high cholesterol levels only, it’s because your neighbor has a reading of greater than 200 mg/dL if the LDL is too high.

One difficulty with statin drugs is that an individual cannot discontinue them once their cholesterol levels are lowered to an acceptable range unless major modifications are made for lifestyle changes. For example, if a person were to discontinue eating fried foods, snacks with tropical oils, and other food products high in cholesterol, reduce salt intake, exercise about 30 minutes almost every day of the week, quite smoking, reduce stress and more, he or she might be successful enough to discontinue the drug. Otherwise, the statin or other cholesterol-lowering drug is relatively permanent and must be taken indefinitely on a daily basis.

Then there are the side effects, which is why your neighbor was probably told to go off the drug. While often well-tolerated, statins have been found to cause muscle pain, confusion, memory loss, diarrhea, constipation, weight gain, upper abdominal pain, loss of appetite, insomnia, headache, dark urine, pain on urination, and nausea. While rare, the use of statins can cause liver damage. A person on a drug in this category must have periodic blood testing to determine if the liver is affected and if the drug should be discontinued. I must add here that while research is ongoing, the FDA issued a statement carried by the Wall Street Journal on February 29, 2012, warning that patients taking cholesterol-fighting statins face a small increase in the risk of higher blood sugar levels and being diagnosed with diabetes. At the time, the warning wasn’t expected to suggest to doctors they discontinue prescribing statins for patients with multiple risk factors for heart attack, and indicated cardiologists feel the benefits of statins still outweigh the risks. The FDA announced drug makers could remove label warnings that lab testing should be monitored during statin therapy, stating serious liver injury with statins is rare and unpredictable, that periodic monitoring didn’t appear effective in detecting or preventing the rare side effect. Numerous studies ensued (including one with over 90,000 patients) published in the Lancet in 2010. The conclusion was that statin therapy is associated with a minimally increased risk of development of type II diabetes. In terms of the breakdown of muscle cells, – a condition known as rhabdomyolysis that can release the protein myoglobin into the bloodstream, the study also found the risk to be low. Specific drugs include Lopid, Restasis, Sandimmune, Niacor, Niaspan, and anti-fungal meds taken in conjunction are a risk for elevated glucose levels, type II diabetes, memory loss and confusion; fortunately, it appears the memory loss and confusion will disappear if the statin is discontinued.

One option is to consider an over-the-counter cholesterol lowering drug such as niacin or Cholest-Off and similar products that contain plant sterols and stanols; however, your friend should run these options past her physician first.

A: To begin with, the regular use of niacin can be preceded by either diphenhydramine (Benadryl) or aspirin that will prevent the flushing aspect that is so difficult for patients to deal with. However, I strongly urge you to speak with your primary care physician before putting this into play because of an anti-coagulant issue that could present problems for some individuals.

Inositol hexanicotinate is used for a variety of conditions to include hypertension, insomnia, atherosclerosis, restless legs syndrome, poor circulation, Raynaud’s disease, high cholesterol levels, and more. It is a compound of niacin (vitamin B3) and inositol. This form of niacin is purported to reduce or prevent flushing, simply because it breaks down at a slower rate. Inositol hexanicotinate appears safe for most individuals, works to reduce cholesterol levels in some people but the results of tests are contradictory. It does not release the active form of niacin and can cause unwanted side effects in others, to include nausea, stomach upset, headache, hiccups, and indigestion. There appears to be some reports of possible liver damage in some patients and questions remain if it actually helps lower cholesterol levels.

Some patients are warned not to take the product if they have a history of kidney disorders, angina, diabetes, allergies, gout, hypotension, gallbladder disorders and more. The chronic use of inositol hexanicotinate might increase blood sugar levels and thus, decrease the effectiveness of diabetic medications. Therefore, individuals who choose to take it should have their sugar levels closely monitored. Further, it may also slow blood clotting so taking it with prescription medications to slow the clotting process could result in easy bruising and bleeding.

Because the product works to lower cholesterol levels in some individuals and not in others, I might opt for other methods to lower your readings such as a trial of the prescription Niaspan which is regulated and considered both safe and effective. Consider avoiding saturated fats in your daily diet. Substitute what you are using with olive or canola oil. Reduce your consumption of marbled or fatty beef and fill in with broiled fish or chicken. Fish is an excellent means of lowering cholesterol levels because of the omega 3 oils. Increase your dietary fiber by eating more whole grains, fresh fruits and vegetables. Sprinkle flax seed on your toast or cereal in the morning and nibble on walnuts or almonds when you get hungry. If these methods fail to work after a period of time, ask your physician what he or she would recommend as a natural remedy first prior to getting into a prescription medication.

Readers who would like related information can order Dr. Gott’s Health Report “Cholesterol” by sending a self-addressed, stamped number 10 envelope and a $2 US check or money order to Dr. Gott’s Health Report, PO Box 433, Lakeville, CT 06039. Be sure to mention thew title or print an order form from www.AskDrGottMD.com.

For some years now I have taken the oat bran and psyllium and my cholesterol has remained low with the “good” cholesterol being “ideal”. I don’t like to take drugs, and recently reduced my Lipitor to 5 mg every other day. On my next blood work test next month, I will find out my new count. I’d much rather take the oat bran and psyllium than the Lipitor.

A: Lipitor is one of the most common cholesterol-lowering statin drugs on the market. Statins work to lower “bad” LDL cholesterol and raise “good” HDL cholesterol. They are prescribed for individuals in which diet and exercise alone are not enough to bring levels under control, have a history of heart attack or stroke, and/or have other risk factors for cardiovascular disease.

Statins, while beneficial for many users, carry many side effects with some being potentially serious. The most common is muscle and joint pain that results from the drug’s ability to deplete co-enzyme Q10. This can usually be combated by simply taking a Co-Q10 supplement; however, understandably, many individuals would prefer to not be on a prescription medication. That is where home remedies and alternative therapies come into play with varying degrees of effectiveness and safety.

The oat bran and psyllium you are taking are both forms of fiber. Psyllium is commonly used to treat constipation and maintain regularity and has been shown to lower LDL cholesterol. Oat bran has been shown to improve cholesterol numbers. Other common alternatives include red rice yeast (which contains a natural form of lovastatin, the active ingredient in the prescription statin drug Mevacor), plant stanols and sterols, garlic, blond psyllium, barley, and more.

Those interested in trying alternatives should always discuss the issue with their physicians prior to use. This is to ensure that the risk of interaction between other supplements and drugs also being taken are kept to a minimum, as well as aiding the physician should side effects or complications arise.

Readers who are interested in learning more can order Dr. Gott’s Health Reports “Dr. Gott’s Compelling Home Remedies” and “Understanding Cholesterol” by sending a self-addressed, stamped number 10 envelope and $2 (for each report) to Peter H. Gott, MD Health Reports, PO Box 433, Lakeville, CT 06039. Be sure to mention the title(s) or print an order form from www.AskDrGottMD.com.

My overall cholesterol was 152 with my HDL being low at 33. Triglycerides 155. All other blood work was normal. After the initial interview, I had a stress test which I failed because I only lasted a bit over four minutes. No shortness of breath, no chest pain, no discomfort other than my legs got tired. Also, an EKG was done which showed something abnormal, but he said “no event”. He then scheduled me for a heart cath which I had done. The results showed a 10% blockage throughout my system. He said because I had three risk factors – mother died of a heart attack at 85 after a lifetime of smoking, my BMI is 26 and my HDL was low, he prescribed Zocor 2 mg. I am reluctant to start a cholesterol lowering drug unless it is necessary. I would like your thoughts on this.

DEAR READER: Total cholesterol is an indicator of potential risk for developing heart disease. A physician may choose to focus on a patient’s low density lipoprotein (LDL) figure because this number is considered to be a better measure for cardiac-related issues than is the total cholesterol number. Simply put, total cholesterol without other factors is considered good at below 200. Low density lipoproteins (LDL) should be below 70 for those individuals at very high risk of developing heart disease. High density lipoproteins (HDL) should be 60 or higher, while triglycerides, a type of fat in the blood, should be below 150.

Cholesterol figures are measured in milligrams (mg) of cholesterol per deciliter (dL). In our country and for healthy individuals, readings between 200 and 239 are considered to be borderline high. Figures above 240 are high. HDL (good cholesterol) are ideal at 60 and considered poor below 40 for men and 50 for women. LDL (bad cholesterol) should be below 70 for those individuals at very high risk of developing heart disease; below 100 for those at average risk of heart disease; near ideal between 100-129; borderline high between 130-159; high between 160-189; and lastly very high at 190 and above. Triglycerides are most desirable below 150; borderline if the numbers range from 150-199; high between 200-499; and very high at 500 and above. I must interject here that the American Heart Association endorses an optimal triglyceride level of 100 mg/dL; however, they do not recommend drug treatment to get to that level since lifestyle modifications such as weight loss and dietary changes can bring figures down substantially.

Without periodic laboratory testing, a patient might never know he or she has a problem with cholesterol numbers and one of the biggest issues we must face (which is out of our control) is genetics. We might eat right, exercise, discontinue smoking, and do all the right things but fall into a bracket of being high simply because of our genetic makeup. Risk factors for development of a cardiac condition include a family history of heart problems, a prior history of heart attack or stroke, a history of smoking, diabetes, high cholesterol (especially the LDL), advanced age, and hypertension.

All that said, I don’t believe that you require a statin medication. Your family history is based on one individual with a long history of smoking, your BMI is barely above normal, meaning that while you may be a few pounds over ideal, you are by no means overweight and finally, although your HDL is low, you make no mention of your LDL and statins are designed to lower the bad cholesterol, not raise the good. Zocor (simvastatin) is not available in a 2 mg dose. It is available as 5-40 mg pills so the smallest amount you could conceivably take is a half a 5 mg for 2.5 mg but this is far from the norm with 10-20 mg the common starting dosage. And, finally, you didn’t fail your stress test because of a heart problem, but rather from physical conditioning. A 10% blockage found during your heart catheterization (in my opinion, an unnecessary test in your case) is insignificant.

My recommendation is to find a new cardiologist and in the interim, make some lifestyle and dietary changes. Avoid high fat foods and red meats. Include more fish and omega-3 fatty acids in your diet. Don’t forget to include fresh fruits, vegetables and whole grains. Try to exercise at least 30 minutes a day by walking, biking, jogging or other heart-healthy cardiovascular activities.

Readers who would like related information can order my Health Report “”Understanding Cholesterol” by sending a self-addressed, stamped number 10 envelope and a $2 US check or money order to my attention at PO Box 433, Lakeville, CT 06039. Be sure to mention the title when writing or print out an order form from my website www.AskDrGottMD.com.

I’m terrified of statin side effects and wonder why doctors push so hard to prescribe statin meds.

DEAR READER: VonWillebrand’s results from a deficiency in or impairment of a protein in the blood clotting process. Essentially, those with the condition will take longer to stop bleeding when they are cut and longer than normal to form clots. This can occur during a particularly heavy menstrual flow, from bleeding of the gums following tooth brushing, a razor cut, nosebleed, tooth extraction, and countless other conditions that occur every day.

Essentially, the cause is an hereditary defect in the gene that controls a protein known as the von Willebrand factor. During a malfunction, platelets cannot stick together as they were designed to, nor can they attach themselves to the blood vessel walls normally when an injury occurs. The result is uncontrolled bleeding. Most cases are autosomal dominant inherited, implying a person only needs one abnormal gene from one parent to be so affected. If a person has the gene for von Willebrand, he or she has a 50% chance of passing that gene to any offspring. The most severe form, type 3, is autosomal recessive, meaning both parents would have to pass the abnormal gene on for offspring to be affected.

There are three major types of the disorder. The first and most common is referred to as type 1. Symptoms are generally mild. In some of the individuals in this category, levels of factor VIII are also low. Type 2 symptoms tend to be more significant. In type 3, which is very rare, the von Willebrand factor is absent and levels of factor VIII are low. Signs will likely be severe and there may be bleeding into muscles and joints.

This is a life-long condition that has no cure, yet it can be treated effectively by a physician. The type of treatment used will vary, depending on the severity of the disorder and whether or not prior methods had been effective. The first step is often desmopressin (DDAVP), a medication that is administered into a vein or through a nasal spray. This synthetic hormone controls bleeding by stimulating the body to release additional von Willebrand factor stored in the lining of the blood vessels. DDAVP is often effective in treating type 1 and some subtypes of type 2.

Replacement therapy consists of the infusion of prepared doses of concentrated blood-clotting factors that contain von Willebrand factor, as well as factor VIII. If DDAVP doesn’t provide good results, this may be useful for all types of the disorder.

Medications that are clot-stabilizing can slow the breakdown of clotting factors which, in turn, can keep a clot in place once it has formed. This may be an option for those who must undergo tooth extraction or a surgical procedure.

On the home front, anticoagulant medication such as aspirin or warfarin should be not taken without the consent of a hematologist or primary care physician. Acetaminophen should be the replacement. Some anti-depressants can cause mild platelet dysfunction and obviously should not be taken.

Remain as active as possible; however, avoid contact sports that can cause bruising and other injuries. Restrict activities to walking, biking, tennis, swimming, yoga, tai chi, and other non-contact activities.

Because some people with the disorder have extremely mild signs, the condition can be difficult to diagnose. Those who feel they may have a bleeding disorder should be under the care of a hematologist who will perform blood tests.

If you haven’t done so already, I recommend you seek a second opinion from a hematologist before going on a statin drug. While one will reduce your total cholesterol which will subsequently lower your risk factor for developing cardiovascular disease, I have never heard of anyone having a blood level of 70. Perhaps you misunderstood your physician who is actually attempting to bring your LDL (“bad”) cholesterol down to 70 or lower rather than your total cholesterol level. Do you have a cardiac condition you failed to mention? Are there other issues you haven’t mentioned? Get the facts and weigh them carefully before you make a decision in this regard.

Readers who would like related information can order my Health Report “Understanding Cholesterol” by sending a self-addressed, stamped number 10 envelope and a $2 US check or money order to my attention at PO Box 433, Lakeville, CT 06039. Be sure to mention the title when writing or print out an order form from my website www.AskDrGottMD.com.

Oat bran is the hull of the oats we normally eat. It can be purchased from health food stores across the states or online so I got some and started incorporating the normal two tablespoons into my daily diet. After two weeks of this in my diet, I had a blood test run by my cardiologist. When I went in for my exam, the doctor almost dropped his teeth. My triglycerides had dropped from 209 the previous exam 7 months earlier to 128. My HDL went from 41 to 38 and my AST went from 42 to 27. With results like this I felt I needed to share with others in the same fix.

I now routinely incorporate two tablespoons of oat bran into each day. This can be done in any number of ways. One the French doctor recommended was in a high protein pancake eaten each morning. Simple mix two tablespoons oat bran, two tablespoons Greek yogurt, one egg white, and one packet of Splenda. Pour it into a lightly oiled skillet and cook for about 5 minutes on each side. Once finished, you can put sliced meat of your choice on it and roll it up for a breakfast on the go. One pancake keeps me full for about four hours.

Hope this helps many of your readers.

DEAR READER: Oat bran is an excellent source of soluble fiber which is known to decrease LDL cholesterol levels to a degree. Fiber is also beneficial in relieving and preventing constipation but must be increased slowly.

While your drop in triglycerides is certainly remarkable, I am a bit concerned that your HDL (good cholesterol) also dropped. I would also be interested in learning what your LDL (bad cholesterol) and total cholesterol numbers were prior to and following your oat bran addition. The AST test is used to measure a liver enzyme and is often used to monitor liver disease. In your instance, you were likely tested because you are taking a statin drug which can cause liver problems in some individuals.

The high protein pancake that you mention certainly sounds like a great breakfast alternative, but again, I would urge caution when adding meat to it, as animal products, especially certain types of meats and high fat dairy products, can increase the cholesterol level. If you were to add a few thin slices of lean chicken or turkey breast (not the luncheon meat variety), you would lower the fat content but keep the protein. Meats such as roast beef, ham, salami, bacon, and others have a high fat content and won’t benefit you in lowering your cholesterol levels. Also, Splenda, a sugar substitute, should be used in moderation. Perhaps a small amount of honey, applesauce or another natural sweetener would be better.

All in all, I’m not entirely convinced that the oat bran itself is what brought your numbers down. I think it may simply be the fact that you are now eating a more healthful breakfast than you were previously and this simple change caused a dramatic effect. Eating a high fiber, low fat diet can do wonders in lowering cholesterol as can increasing exercise. Because the pancake recommended by you and the French doctor you mention sounds healthful, nutritious and delicious, I would certainly have no problem with my readers trying it, but I urge other dietary and lifestyle changes with it. Thank you for sharing.

Readers who are interested in learning more can order my Health Report “Understanding Cholesterol” by sending a self-addressed, stamped number 10 envelope and a $2 US check or money order to Dr. Peter Gott, PO Box 433, Lakeville, CT 06039. Be sure to mention the title or print an order form from my website, www.AskDrGottMD.com.

I eat a balanced diet consisting of beans and legumes for protein and I cook with olive oil and other “good” fats. I consume two to three ounces of red wine with dinner nightly. Despite all this, my cholesterol is 221 and my triglycerides are 195. My HDL is 59 (I worked hard to raise it from 50) and my LDL is 123. I am dumbfounded! How can I lower my cholesterol and triglycerides further? Also, the lab collected blood after a 5 hour fast only and they did not instruct me to abstain from alcohol for 24 hours. Did this alter my results? Any advice would be much appreciated.

DEAR READER: For the record, target goals for HDL (the good cholesterol) are between 40 and 60mg/dL with higher numbers better than lower ones. LDL (the bad cholesterol) should be between 70 and 130 mg/dL with the lower numbers preferred. Triglycerides have a broad range of between 10 and 150 mg/dL, with the lower numbers better, and total cholesterol should, under most circumstances, be less than 200 mg/dL. There are specific medical disorders such as cardiac disease in which a physician might prefer a patient remain substantially lower than the norm for this category.

Your five-hour fast before the testing isn’t generally sufficient. In most instances, physicians urge patients to fast for nine to 12 hours prior to testing, so this may play a role in your abnormal results. I suggest you request a repeat test in which you have fasted for 12 hours prior to testing to determine if this played a role.

Beyond that, it appears you are doing all you can to address your hypercholesterolemia; however, I may be able to offer some reasons why your levels are not lower that you haven’t considered. You suffer from hypothyroidism, for which you take Synthroid. An underactive thyroid gland (and diabetes) can lead to high cholesterol levels. Beyond that, is there a possibility you may be taking birth control pills, a diuretic, estrogen, or one of several medications for depression — all of which can increase cholesterol levels? Have you had polycystic ovary syndrome, or kidney disease? Do you smoke? While the habit will not elevate your total cholesterol count, it can lower your HDL (good cholesterol) figure. Then, perhaps last but not least, do you have a family history of high levels? This can be rather frustrating because, as you may have discovered, no matter what you do your family history of disease can be tough to overcome. If this is the case, you may need to be placed on a cholesterol-lowering drug – either an over-the-counter or prescription.

I know a number of individuals who will not take a statin drug because of the bad publicity for medications in this class. Instead, they prefer taking over-the-counter plant stanols and sterols such as Cholest-Off; others sprinkle flax seed on their cereal and other foods throughout the day; some take flaxseed oil capsules for convenience every day. Have you considered vitamin B3 (niacin), or tried adding a teaspoon of cinnamon to your daily diet? These simpler options may not work but they also might help you reach your goal. Become educated by reading labels. Eliminate saturated fats and trans fats from your diet. Replace them with whole grains, fresh fruits and vegetables.

Readers who would like additional information can order my Health Reports “Understanding Cholesterol” and “Compelling Home Remedies” by sending a self-addressed, stamped number 10 envelope and $2 (for each report) US or money order to my attention at PO Box 433, Lakeville, CT 06039. Be sure to mention the title(s) when writing or print out an order form from my website www.AskDrGottMD.com.

DEAR READER: Let me take a moment to explain to readers just what the product is before I attempt to answer your question. Red yeast rice is actually rice fermented with Monascus purpureus. It contains several compounds that together are known as monacolins, known to inhibit the formation of cholesterol and which may lower cholesterol levels. Red yeast has a similar chemical make-up to that of lovastatin (Mevacor) and certain other statin drugs and therefore may carry similar side effects.

This traditional Chinese medicine is sold over-the-counter as a cholesterol-lowering agent; however, legal issues abound as to whether it is a dietary supplement or an actual drug, due to its similarities to statins. Herein is the problem. This seemingly “natural” product contains a substance very similar to one classified as a prescription drug. And, as we’ve read about many times, lovastatin has the ability to cause an increased risk for the development of severe muscle problems such as aches and cramping that could go on to cause kidney disease. There are numerous reports of muscle myopathy and liver damage resulting from the product’s usage.

Four years ago the Food and Drug Administration attempted to control the sale of red yeast rice by asking three companies to withdraw the product from the market because of the single ingredient. It disappeared from store shelves for a few years but is back with at least 30 brands available today. Many suppliers avoid FDA restrictions by not claiming the product can lower cholesterol levels which means it is not subject to FDA action.

The safety of red yeast products has not been established, nor are the effects of long-term use known. In fact, the American Heart Association warns against its use until the studies of long-term use are in. Some of the products sold in our country contain little to no statins. Others contain excessive amounts. Therefore, it remains unknown if these products actually do anything to help reduce levels. It is believed the product can be taken without harm for up to three months; however, there is insufficient information to determine its safety beyond that period. Side effects other than severe muscle pain and muscle damage include abdominal discomfort, heartburn, intestinal gas and more.

Red yeast should not be taken if an individual is on any other medication that could harm the liver, such as acetaminophen (Tylenol and others), erythromycin (Emycin), amiodarone (Cordarone), phenytoin (Dilantin), simvastatin (Zocor) and a number of others. Anyone considering the product should check with his or her physician prior to making the decision to begin the supplement.

Were I to guide you, I would recommend you consider other seemingly harmless options beforehand, such as adding a teaspoon of cinnamon to your daily diet or taking over-the-counter niacin. The latter can cause flushing or itching so it may be necessary to precede the dose with an antihistamine or 8l mg aspirin.

Readers who would like related information can order my Health Reports “Understanding Cholesterol” and “Compelling Home Remedies” by sending a self-addressed, stamped number 10 envelope and $2 US for each report to Dr. Peter Gott, PO Box 433, Lakeville, CT 06039. Be sure to mention the title when writing or print out an order form from my website www.AskDrGottMD.com.

My doctor suggested I reduce the dosage to 10 mg and then to 5, which hasn’t stopped my pain. He currently has me on Lipitor/atorvastatin 5 mg, but the problem persists. My recent lipid panel showed the following: cholesterol 172 HDL 33; LDL 105, triglycerides 177 and A1C 6.7.

These drugs are not cheap. I can’t keep trying this and trying that, so what should I do?

DEAR READER: It would certainly help me to know your medical background because without a cause other than your cholesterol (such as cardiovascular disease or diabetes), your readings are within normal limits with the exception of your A1C. The American Diabetes Association recommends an A1C of less than 7.0, while the American Association of Clinical Endocrinologists recommends 6.5 or lower. The risk of heart attack increases with higher readings.

Your physician apparently prescribed statin drugs to both lower your cholesterol levels and reduce the risk of stroke or heart attack. However, as you point out, the side effects can be mighty frustrating, with muscle pain heading the list. Less common issues include nausea, gas, diarrhea and constipation.

The use of statin drugs also requires periodic blood testing to check for liver damage. Statins cause the liver to abnormally increase its production of enzymes. An elevation could prompt your physician to recommend you stop taking the drug for a period of time until your levels fall within the normal range.

I am concerned about your numb fingers. Are you a smoker? Could something else be going on that you are blaming statin drugs for? I suggest a complete physical examination and — if necessary — referral to a vascular specialist. I may be jumping to incorrect conclusions, but I want you to cover all the bases in this instance.

Ask your physician to switch to a non-statin drug for control of your cholesterol. Over-the-counters include products with plant sterols and stanols, cinnamon sprinkled on your food, niacin (vitamin B3), omega-3 fish oil and flaxseed. They may not be as effective as expensive prescription drugs, so it’s a matter of the risks outweighing the benefits in this case. It’s a situation best discussed with your doctor.

Readers who would like related information can order my Health Reports “Understanding Cholesterol” and “Compelling Home Remedies” by sending a self-addressed, stamped No. 10 envelope and a $2 U.S. check or money order for each report to Dr. Peter Gott, P.O. Box 433, Lakeville, CT 06039. Be sure to mention the title(s), or print an order form from my website’s direct link: www.AskDrGottMD.com/order_form.pdf.

My first cholesterol test when I was in my 20s was over 250. All subsequent tests have been between 230 and 260. My HDL is always over 80, often over 100. My LDL varies from low to borderline, and my triglycerides are usually low.

I take 1 gram flaxseed oil, 1.2 grams omega-3 fish oil and 750 mg niacin daily, and twice daily take 1,200 mg red yeast rice, 630 mg calcium, 900 mg vitamin D, 150 mg sytrinol and 27 mg iron. A few years ago I was taking 1.5 grams of niacin daily, but my liver panel showed some odd numbers, so I cut down to 750 mg and the oddities disappeared.

In short, any diet, supplement and lifestyle changes I have made apparently have had no effect on my cholesterol numbers whatsoever. Is there any other way humanly possible to lower them? My high total makes me uninsurable, despite the positive HDL. My doctor is concerned and is encouraging me to try one of the statins, which I am reluctant to do.

My father had a multiple bypass with an 85 percent blockage in some arteries when he was exactly my age, but my parents’ generation did not exercise.

I’d be interested to hear your thoughts on this.

DEAR READER: The answer is fairly simple. Your total cholesterol is high because your HDL is high. HDL — high-density lipoproteins, or “good” cholesterol — is responsible for returning excess LDL and VLDL (low- and very-low-density lipoproteins, “bad” cholesterol) back to the liver. Picture your blood vessels as a street. VLDL and LDL are dirt, leaves and trash clogging up the road, and HDL is the street sweeper.

To the best of my knowledge, there is no upper limit to HDL levels. “The higher the better” is what physician’s currently say because HDL levels above 60 are associated with a decreased risk of heart disease.

I don’t think you need to worry about your total cholesterol numbers. Your HDL is excellent and your LDL and triglycerides are low to normal. You also have an exemplary diet and exercise routine. I don’t believe there is cause for concern, but I suggest you talk to your physician about why he is concerned, and why he wants you on a statin.

Given your family history, perhaps an appointment with a cardiologist is in order just to be sure. There is a familial condition with elevated HDL and (paradoxically) an increase in the formation of arteriosclerosis. Most of the time, elevated HDL is cardiac-protective, but there is a subset that is not. Perhaps you fall into this category.

Remember, just because your doctor wants you to take a medication (any medication, from antibiotics to statins to antidepressants) doesn’t mean you have to. What you must be is well informed. Find out what he or she wants you to take, why, and what risks may be present if you refuse.

Readers who are interested in learning more can order my Health Report “Understanding Cholesterol” by sending a self-addressed, stamped No. 10 envelope and a $2 U.S. check or money order for each report to Dr. Peter Gott, P.O. Box 433, Lakeville, CT 06039. Be sure to mention the title( or print an order form from my website’s direct link: www.AskDrGottMD.com/order_form.pdf.