Peter Hibberd, M.D., is a doctor whose advice is based on more than 28 years of hospital outpatient and inpatient experience. He is an experienced emergency medicine physician, surgeon, and consultant. Dr. Hibberd is certified by the American Board of Emergency Medicine. He is also a fellow and active member of the American Academy of Family Physicians, an active member of the American College of Emergency Physicians, and a member and fellow of the American Academy of Emergency Medicine. Dr. Hibberd has earned numerous national and international professional certifications, memberships, and awards.

Difficulty Controlling Cholesterol

Wednesday, 07 September 2011 08:16 AM

Question: I can't take statins, and my total cholesterol is in the mid 300s. I take many vitamins and supplements, such as krill oil, niacin, calcium, magnesium, zinc, vitamin D, vitamin C, a multivitamin, and an occasional aspirin. So far it hasn't helped much. I heard on TV that if your cholesterol is in big chunks, it is not as life-threatening as it is in smaller molecules.
Is this true, and is there anything else to get my cholesterol numbers down? How can I find out if I have the bigger or smaller molecules of cholesterol? My doctor says it's hereditary and can't be controlled by diet. I try to stay below 1,000 calories because I have a fatty liver and am told I need to lose weight, even though I wear size 8 jeans.
Dr. Hibberd's Answer:

You appear to be self-directing much of your treatment. Sometimes supplementation consisting of random guesses actually causes more harm than good, not to mention the aggravation of trying to keep up with all these pills.

Ask your doctor to guide you or refer you to a lipid specialist, or seek out an alternative primary care physician if your current one appears disinterested. Hypercholesterolemia may be largely genetic, and diet will impact your values by only 10 to 20 percent at most, but that does not mean we have ineffective treatments. We do have very effective medications to control elevated lipids (cholesterol and/or triglycerides).

It is time to be aggressive in managing your disease. Arm yourself with medical consultants you can trust, and get started with risk-reduction strategies now. Aim for an LDL of less than 100 and an HDL of over 60, with triglycerides less than 150. Maintain healthy exercise and dietary patterns, and optimize your weight to a healthy target BMI of less than 22 (aim for 18 percent for female and 12 percent for male). Your waist size may relate to your mortality but not to your disease risk.

Forget the small particle/large particle debates ... they are useful academically but not clinically in the large majority of patients since the test findings rarely cause a change in treatment.

The more elaborate and expensive microparticle tests ARE useful in those with normal lipid values who are at risk for or have had vascular or cardiac events with initial normal lipid screens (this is not you). They are also used to ascertain and measure improvement in risk (that routine testing or screening has missed) once an aggressive lipid management program is in place.

Be sure underlying conditions such as hypothyroidism and diabetes are well-controlled, as these by themselves will impact your cholesterol values adversely if not well-managed. The fatty liver is probably a result of elevated cholesterol and/or triglycerides, and will usually correct with appropriate lipid management.

Start with a high soluble-fiber diet and seek professional advice on your lipid management without delay.

As regards to the statins, a reaction to one generation of statins does not mean the next generation will create problems. Many of the first generation, such as Mevacor, created many side effects that have been lessened in later generations since they appear to act slightly differently in different individuals. I rarely see reactions with Lipitor when Co-Q10 is added as a supplement, and I rarely see reactions in patients who are taking Crestor, a fourth generation drug.

Triglyceride management has been revolutionized in many patients without having to resort to additional medications by widespread use of Lovaza (FDA purity prescription DHA/EHA omega-3). Lipid-rich plaque will deposit rapidly with cholesterol values of 300. This plaque in your vessels accumulates and destabilizes easily. This predisposes you to unstable plaque complications that include premature heart attack and stroke.

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