DEAR DR. GOTT: I am a 59-year-old female, about 145 pounds (I should be 135). For about 10 years, I have eaten no mammal meat, have excluded milk and dairy from my diet, and have avoided shellfish. I start each day with a bowl of cooked oat bran with soy milk. I average more than 30 grams of soluble and insoluble fiber per day. I eat salmon, tuna and a little poultry. I exercise vigorously at least three times a week and wear a heart monitor so I get at least 25 minutes in the 75- to 90-percent maximum zone. My blood pressure averages 102/58.
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.
