Question: Are there alternative medicines and methods to lower cholesterol? Does niacin work? I do try to eat properly and cut out red meat, but is this hype? And is it unreasonable of me to avoid chemicals?

Dr. Hibberd's Answer:

I have always maintained that the less medication used, the better. Lowering cholesterol has always been more difficult without the aid of prescription drugs. The availability of effective and relatively safe treatment option to lower cholesterol, manage blood pressure and aggressive cardiac and stroke intervention has revolutionized our approaches to cardiovascular health.

The relative simplicity of statin therapy with such great returns in the form of risk reduction is very difficult to ignore. Remember, it wasn't long ago that a male with heart disease could expect his first heart attack in his late 40s and to succumb to this or a repeat heart attack within five years. We can’t prove that these therapies have extended individual lifespans, but they have definitely improved our quality of life. Some victims of cardiovascular disease can now remain active, where in previous decades they may have become disabled victims of vascular disease.

There will always be naysayers for various treatments, and I always encourage patients to weigh risk/benefit ratios using informed sources. Please avoid generic Internet searches that are often full of as much fiction as fact. As an emergency physician, I am on the front line receiving critical patients. I deal with life and death every day, and it is amazing how often very simple measures can make such a huge difference in outcome, especially with cardiac disease and strokes. Here are some simple points for patients at risk for vascular disease:

1) Aggressively manage underlying risk factors within your own individual tolerances for change (diabetes, blood pressure, weight management, regular exercise, NO smoking, cholesterol control).
2) Eat like a rabbit. Avoid saturated fat, red meat soaked in hormone and growth agents, fish laced with pollutants such as lead and mercury, and fruits and vegetables laced with chemicals and pesticides that have caused much suffering among our population.
3) Supplement for areas in your diet where deficiency is expected or present, but avoid random supplementation which often causes its own problems.
4) Do not treat yourself. Consult a specialist who can guide you using modern methods with an evidence base. No old wives tales please—just the facts!
5) Avoid being discouraged by others who make a profit capitalizing on your concern with "secret" information only available when you pay them.
6) Be proactive with your health, and be sure to find a physician with your own mind-set for risk management and health prevention.
7) Diets high in soluble fiber will help control elevated cholesterol levels, possibly as effective as strict dietary restriction.(Some take 1 tablespoon of Metamucil two or three times a day with good results.)
8) Niacin is vitamin B3, and it is good if you can tolerate it without adverse effects or medication interactions. Doses of more than 500 mg need a doctor’s supervision. Doses up to 3000 mg are used under physician supervision with periodic lab guidance. Beware of slow-release preparations that may be dangerous.
9) Fish oil is generally good and often improves lipid management, but beware of manufacturer purity statements.
10) Be sure to get adequate calcium and vitamin D, along with at least 10 to 20 minutes of sunlight daily so your body can synthesize vitamin D and properly use available calcium.