So traditionally speaking, high cholesterol is when we have a total cholesterol of over 200, an LDL reading of over 100, triglycerides that are over 120, and HDLs less than about 45. We want HDLs higher.
HDLs are protective in that they typically take cholesterol from the arteries back to the liver, and LDLs take cholesterol back into the arteries from the liver. So we like to have the LDLs lower and the HDLs a little bit higher.
Triglycerides will tell us how much carbohydrate a person is typically taking in, and how well they're handling that carbohydrate. So we like to see that number lower.
So the reason why high cholesterol is deemed problematic, is that typically, if cholesterol is elevated chronically, we tend to have an elevated correlation with cardiovascular disease. So what this can look like for a person is being an increased risk for things like heart attack and stroke. And along with major complications like that, we can also see occlusion of the vessels, which eventually leads to a compromise in circulation to the legs or the arms. We can also see a decrease in cognitive function because the brain isn't getting adequate circulation.
When a person comes to see me for high cholesterol issues, we spend a lot of time during the initial two-hour consult focused on history. I really want to know what that person's diet looks like. I also want to know what their exercise patterns look like, and I want to know what their stress levels are.
After we've established that information, I want to get some testing done so we can confirm that the levels are actually high, and so in addition to the traditional tests, like the total cholesterol, the LDL, the HDL levels, and the triglycerides, I'm also going to run LDL density. I'm going to look at lipoprotein(a) and homocysteine, and I'm going to run apoA and apoB levels as well.
I'm going to get a very thorough physical examination on them as well during that initial consult, and we're going to look at things like blood pressure, we're going to look at things like hip circumference, and we're going to look at weight.
So when I get labs back, that confirm the person actually is struggling with high cholesterol, the very first thing we do is we look at diet. We remove anything that's causing a problem, and so the primary problems in diet are refined carbohydrates and processed foods.
So what this means is looking at any sugars and any flours, so cereals, pancakes, muffins, bagels, bread, pasta, crackers, these are all things that are very problematic in terms of raising cholesterol.
Any type of trans-fats are problematic, so just really taking out any type of processed food, we want to encourage everyone to eat organic foods so that they're not getting any type of excess chemicals, hormones, GMO foods into their body, because these are also very inflammatory and cause problems long-term.
So good foods to focus on are fiber, and so for example, a person could eat a steel-cut oats for breakfast with some oat bran and some fresh fruit and some nuts, and that would actually be a very good breakfast that would help lower cholesterol. Lots of good quality organic proteins, fresh vegetables and fruits, nuts and seeds, lots of good oils, so fish oil, flax oil; we can do avocado and some coconut oils here are just find very good for the body.
So in addition to diet changes, I also ask my patients to add some exercise to their routine. Many of my patients are sedentary when they first come to me, and this is part of the problem. So adding 30 minutes of movement daily is what I ask from my patients.
I also recommend three major supplements. I put all my patients with cholesterol problems on fish oil, I have them take a tablespoon a day, and this is so that they're getting at least 3 grams of EPA+DHA, which are important to bring down inflammation, which is associated with elevated cholesterol. In addition, it's going to take the small dense LDL particles, that are more of a risk factor for cardiovascular disease and events, and change them into the lighter LDL particles which are less of a risk factor.
The other two supplements I like to use are plant sterols and pantothene. The plant sterols will help with decreasing patients' absorption of dietary cholesterol, if they're eating any, and the pantothene will help with lipid metabolism.
So these are supplements that are not used long-term, but they help dramatically with just getting those initial numbers down. Typically, I'll have patients come back in six weeks to three months, depending on what their schedule is like, and we re-test lipids at that point, and we generally see a dramatic shift down with that regimen.
If my patients follow this protocol, I find that their cholesterol comes down and then there is no need for cholesterol-lowering drugs.