Time To Rethink Cholesterol and Statins

Clearing the Confusion Concerning Cholesterol

BY STEVE BORN

With one in four deaths in the US linked to cardiovascular disease (CVD) [1], it’s nothing to brush off. High cholesterol and its link to CVD, and the prescribing of statin medications, continues to be a hot topic, and this “issue” includes athletes as well. As stated in an article on the Medical News Today website, “Although active people usually have lower cholesterol levels, athletes can have high cholesterol. In particular, a high-fat, low carb diet has been linked to higher cholesterol levels in ultra endurance athletes.”[2]

This topic is especially important to you because when it comes to cholesterol and other health issues, most often discussed with your MD, most are “outliers” that don’t fit the mold of the vast majority of patients they see. As a result, they just shrug and try to get you to fit into their boxes anyway. If this resembles your experiences with your healthcare provider, keep reading!

Statin medications are among the most commonly prescribed medications for treating high cholesterol, with annual sales in the billions of dollars [3]. For some individuals, statin medications have been proven to be effective; however, research suggests that statins are being overprescribed and should only be used for high-risk individuals [4, 5].

The problem is the “one size fits all” approach that many health care professionals apply; they continue to look only at Total Cholesterol numbers (HDL + LDL) or LDL only as the primary risk factors for heart disease. They will often suggest that patients—athlete and non-athlete alike—whose Total Cholesterol level is even slightly over the ideal limit of 199 mg/dL begin a regimen of statin medications.

Fortunately, research has shown that there is a marker that is more reliable in determining cardiovascular disease risk than Total Cholesterol or LDL only — the ratio of Triglycerides (TG) to HDL (“good”) cholesterol, or TG:HDL. In the words of highly respected nutritional scientist, Dr. Robert Lustig, “Therefore, the triglyceride-to-HDL ratio – the real ratio of bad to good cholesterol – is the best biomarker of small dense LDL, the best biomarker of cardiovascular disease, and the best surrogate marker for insulin resistance and metabolic syndrome.”

Dr. Mark Hyman agrees: "In fact, your LDL cholesterol is a very bad predictor of your risk of heart disease when compared with the total cholesterol-to-HDL ratio. And this is not as good a predictor as the triglyceride-to-HDL ratio." [6]

The numbers

Before we start calculating the TG to HDL ratio, here are some explanations, standard ranges of cholesterol numbers, and healthy level ranges of cholesterol numbers:

Total Cholesterol is a measure of the total amount of cholesterol in your blood. It includes both low-density lipoprotein (LDL) cholesterol and high-density lipoprotein (HDL) cholesterol.

• Total Cholesterol standard range: 0 - 200 mg/dL
• Total Cholesterol healthy level range: 125 - 199 mg/dL
• Borderline high: 200 - 239 mg/dL
• High: at or above 240 mg/dL

HDL (good) cholesterol – HDL helps remove cholesterol from your arteries.

• HDL Cholesterol standard range: 40 - 90 mg/dL (women) -- 50 mg/dL (men)
• HDL Cholesterol healthy level range: 40 mg/dL or higher (women) -- 50 mg/dL or higher (men)

LDL (bad) cholesterol – The main source of cholesterol buildup and blockage in the arteries.

• LDL Cholesterol standard range: 0 - 130 mg/dL
• LDL Cholesterol healthy level: Less than 100 mg/dL

Non-HDL Cholesterol – This number is your total cholesterol minus your HDL. Non-HDL includes LDL and other types of cholesterol, such as VLDL (very-low-density lipoprotein).

• Non-HDL standard range: 0 - 159 mg/dL
• Non-HDL healthy level: Less than 130 mg/dL

Triglycerides – A form of fat in your blood that can raise the risk for heart disease.

• Triglycerides standard range: 0-150 mg/dL
• Triglycerides healthy level: Less than 150 mg/dL

Total Cholesterol to HDL-C – Total Cholesterol to HDL-C (HDL Cholesterol).

• Total Cholesterol to HDL-C standard range: 0.0 – 5.0
• Total Cholesterol to HDL-C healthy level range: under 3.5

A Better Predictor—The Triglycerides to HDL-C Ratio

To obtain the ratio, divide the TG number by the HDL number.
Example:
TG is 100
HDL is 80
100 divided by 80 = 1.25

• Ideal – TG:HDL is 2 or less
• Very Good – TG:HDL is 2.1 – 2.5
• Good – TG:HDL is 2.6 - 3.0
• High – TG:HDL is 3.1 - 3.5
• Too High – TG:HDL is 3.6 or higher

Dr. Bayne French states: "Strive to have a TG/HDL ratio under 3. The most powerful mechanisms to do this are HABITS. Making a habit out of viewing carb as a garnish, not a staple; having decent physical conditioning; supplementing with things like fish oil; and reserving sugar for the rare special occasion. A high TG/HDL ratio implies sick metabolism. Sick metabolism leads to high insulin levels, insulin resistance, weight gain, diabetes, and eventual heart disease and early death."

The issues with statin medications

For high-risk individuals, statin medications can provide significant benefits for lowering LDL cholesterol, but when prescribed as a preventative for low-risk individuals:

• Those whose Total Cholesterol to HDL-C ratio is ideal at under 3.5
• Those whose Triglycerides to HDL Cholesterol ratio is 2.5 or less
• Those whose Total Cholesterol is above the “magic 200 number” and the low-borderline range (ex: 210 mg/dL)

… statins’ side effects clearly outweigh the benefits.[7] Dr. French elaborates:

There is certainly something powerful biologically going on with statin medications. In addition to lowering cholesterol, they lower inflammation and act as antioxidants. [However], to say that they are universally beneficial and indicated for everyone with elevated cholesterol is grossly inaccurate. Statins likely help reduce CVD in certain situations. Like men under 70 who have already had a heart attack, and men with numerous risk factors (elevated blood pressure, abdominal obesity, diabetes, smoking, etc.). As Abramson et al (BMJ. 2013) reported, for the majority of people for which statins are prescribed (specifically for "primary prevention," people who DO NOT have heart disease), the benefit is lacking, while side effects and risks are significant.

Side effects associated with statin medications

Here are but a few of the side effects—some are obviously quite serious—that may be experienced while on statin medications:

• Fatigue
• Headache
• Memory issues such as confusion, forgetfulness, confusion, and a decreased ability to process information
• Increased blood sugar levels and type 2 diabetes
• Stomach issues such as nausea and diarrhea
• Muscle pain
• Liver and kidney damage

While some of these side effects are considered rare, why flirt with the potential for them to occur if a statin medication isn’t truly needed?

Additional statin issues

It is well known that statins deplete the body’s levels of Coenzyme Q10 (CoQ10), perhaps the most important nutrient for human health. CoQ10 is classified as ubiquinone, from the word “ubiquitous,” because it is present in every cell in the body, CoQ10 produces ATP (adenosine triphosphate = energy) at the cellular level, energy that the body requires to stay healthy and optimize all its functions. Nutritional scientists are universally in agreement about the importance of CoQ10; here are just a couple of comments:

• "Without CoQ10 or a good substitute, human life quickly ends." - James South
  
  
• “That CoQ10 plays a crucial role in aging is beyond doubt. The same applies to CoQ10's role in the immune system. And there is a vital connection between the immune system and aging that cannot be ignored.” - Emile G. Bliznakov MD
  
  
• "CoQ10 is energy on call. I have long considered CoQ10 a wonder nutrient because of its ability to support heart health.” - Dr. Stephen Sinatra
  
  
• “Ubiquinone (CoQ10) is possibly the hub around which life processes revolve in the human body.” - Dr. William V. Judy

It’s clear that CoQ10 is essential for life, yet many who take statin drugs are not made aware of the drug’s negative impact on CoQ10 levels—statin side effects increase with decreased bodily levels of CoQ10—and are thus not taking this all-important nutrient. It is also believed that statin medications may interfere with the synthesis of vitamin K2, which, in tandem with vitamin D3, is crucial for supporting both bone and cardiovascular health. Vitamin K2 activates a protein called osteocalcin, which helps keep calcium out of the arteries while increasing the amount of calcium in the bones (teeth as well). Vitamin K2, working alongside vitamin D3, also promotes healthy glucose metabolism to maintain proper blood sugar levels, thus helping protect against type 2 diabetes.

How to significantly lower cholesterol… by up to 30%

1) Diet first. The most important thing is addressing the diet and correcting dietary errors, primarily excess intake of omega-6 fatty acids. Oxidized blood cholesterol is associated with cardiovascular health disease, and excess linoleic acid (LA) causes cholesterol to oxidize. Linoleic acid is an omega-6 essential fatty acid, and while it is necessary for human health, excess amounts are associated with numerous health disorders, including the earlier-mentioned oxidized blood cholesterol. Conversely, omega-3 fatty acids— EPA and DHA, found in fish, and alpha-linolenic acid (ALA), found in plant sources—are associated with a number of health benefits. The recommended ratio of omega-6 to omega-3 ratio is 4:1; however, most people's diets contain an omega-6 to omega-3 ratio of 20:1 (or higher), much higher than what people are genetically adapted to, and a ratio that is hugely responsible for excessively high cholesterol amounts.

The primary culprit for the omega-6 excess? Increased use and consumption of industrially processed seed oils referred to as vegetable oils. An expert on the subject, Dr. Chris Knobbe, states that these industrially processed seed oils “drive the oxidation. They’re pro-oxidative, proinflammatory, and toxic, but of all of these, it is oxidation. That is by far the worst.”

Cardiovascular research scientist, Dr. James DiNicolantonio, agrees and refers to these omega-6 seed oils as “drivers of coronary heart disease.” He summarizes:

Omega-6 polyunsaturated fat linoleic acid consumption has dramatically increased in the western world, primarily vegetable oils. Numerous evidence shows that omega-6 polyunsaturated fat linoleic acid promotes oxidative stress, oxidized LDL [the "bad" cholesterol], chronic low-grade inflammation, and atherosclerosis. In addition, omega-6 is likely a primary dietary culprit for causing CHD (Coronary Heart Disease), especially when consumed as industrial seed oils, commonly referred to as vegetable oils.

To reestablish the proper balance of omega-6's to omega-3's—helping to protect against serious health outcomes and return us to a much healthier state—we need to greatly reduce or eliminate the consumption of the following oils:

• Canola oil
• Corn oil
• Cottonseed oil
• Grapeseed oil
• Peanut oil
• Rice bran oil
• Safflower oil
• Soy oil
• Sunflower oil

It’s important to remember that most-to-all these highly processed seed oils are found not only in oil form but in processed/fast foods as well, so we also need to strive to eliminate them from our diet. As Dr. Catherine Shanahan, author of Deep Nutrition: Why Your Genes Need Traditional Food, states, "More than any other ingredient, vegetable oil is what puts the ‘junk’ in junk food.”

2) Consistent exercise. Master athletes are reported to have lipid profiles similar to young adults, decreasing their risk of heart disease. One study compared the effects of exercise between 61 master athletes and 51 overweight, sedentary men. The results:

• Plasma high-density lipoprotein cholesterol (HDL-C, the “good” cholesterol) concentrations were 42% higher in the master athletes than in the overweight, sedentary men.
  
  
• Triglyceride (TG) concentrations were 51% lower in the master athletes than in the overweight, sedentary men.
  
  
• Plasma low-density lipoprotein cholesterol (LDL-C, the “bad” cholesterol) levels were 9% lower in the athletes than in the overweight, sedentary men.

Additionally, the American College of Sports Medicine conclusively states:

Endurance training can help maintain and improve various aspects of cardiovascular function and enhance submaximal performance. Importantly, reductions in risk factors associated with disease states (heart disease, diabetes, etc.) improve health status and contribute to an increase in life expectancy.

3) Nutritional supplements. Several nutrients/substances are reported to help lower elevated cholesterol levels. These include:

• Coenzyme Q10 and Trimethylglycine – Race Caps Supreme
  
  
• Acetyl-l-carnitine – Mito Caps
  
  
• Eicosapentaenoic Acid (EPA) and Docosahexaenoic Acid (DHA) – EndurOmega
  
  
• Bifidobacteria longum and Lactobacillus acidophilus – Digest Caps
  
  
• Vitamins B3, B5, B6, and C, and the minerals magnesium and chromium – Premium Insurance Caps
  
  
• Vitamin C – Endurance C
  
  
• Magnesium – Essential Mg, Premium Insurance Caps, Endurolytes products, HEED, Recoverite
  
  
• Chromium – Chromium GTF, Premium Insurance Caps, HEED, Sustained Energy, Perpetuem, Recoverite
  
  
• Soy – Soy Protein, Sustained Energy, Perpetuem
  
  
• Gamma-Tocopherols and Tocotrienols – AO Booster

Summary

Dr. Andrew M. Freeman, referring to the American College of Cardiology/American Heart Association (ACC/AHA) guidelines, states: “Lifestyle, in the form of diet, exercise, stress relief, and connection and support with others, is nature’s best way to improve overall health, including cardiovascular health. We know that making dietary interventions, combined with exercise, can sometimes lower cholesterol as effectively, or even more effectively, than statins.” [8]

Instead of the “one size fits all” approach (Total Cholesterol above 200) or LDL alone to determine the need for statin medications, we agree with Drs. Lustig and Hyman that the most important and reliable method for determining cholesterol’s role in cardiovascular risk is the Triglyceride to HDL ratio (TG:HDL). We believe that those who are at or slightly above the “magic 200 number” in terms of total cholesterol should also look at their TG:HDL ratio and discuss with their health care professionals—and adopt the more-natural strategies listed earlier—instead of simply reaching for a statin medication.

REFERENCES:
[1] https://www.cdc.gov/heartdisease/facts.htm
[2] https://www.medicalnewstoday.com/articles/high-cholesterol-in-endurance-athletes
[3] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3108295/
[4] https://www.acpjournals.org/doi/10.7326/M18-1279
[5] https://pmc.ncbi.nlm.nih.gov/articles/PMC4857879/
[6] https://www.levels.com/blog/the-ultimate-guide-to-understanding-your-cholesterol-panel-and-metabolic-blood-tests
[7] https://hammernutrition.com/blogs/endurance-news-weekly/lipids-a-different-perspective-part-3
[8] https://pmc.ncbi.nlm.nih.gov/articles/PMC10460604/