By PROFESSOR W J SERFONTEIN, MSC, PHD (LEIDEN). .
Raised cholesterol suggests the presence of the metabolic syndrome which in most cases can be managed lifelong with a drug-free dietary regimen.
Patients consult medical doctors because they sense that something is wrong with their bodies – mostly as a result of the presence of certain symptoms which may or may not indicate the cause of their condition. In the majority of cases the symptoms do not directly reflect the cause, and in many cases there is only a vague link or no apparent connection at all between symptoms and cause. The patient, however, is concerned in the first place about the symptoms that he experiences.
For obvious reasons the doctor is keen to satisfy the patient by removing or reducing the symptoms as soon as possible, and in the vast majority of cases the cause remains hidden although treatment of the symptoms may have resulted in temporary ‘improvement’ in the patient’s condition. In this manner a dangerous situation is created because the true cause of the problem remains hidden by the temporary improvement in the symptom profile and the patient may remain at risk for the other consequences that may be caused by the same basic metabolic fault.
In the meantime dangerous and expensive drugs are used to suppress the symptoms. Because they address only the outward symptoms, these drugs do not reduce the health risks associated with the real cause of the problem and they may even be the cause of other, apparently unrelated health problems. In some conditions, treating one or more of the symptoms may bring some temporary relief to the patient, thus creating the false impression that the real cause of the patient’s condition has been addressed. However, no real long-term advantage results from such treatment, and if a serious condition is involved, treating the symptom(s) will not increase life expectancy as may be expected.
Raised cholesterol is among the most frequently occurring symptoms mistakenly seen as a primary disease and cause of heart attacks. In a recent article I addressed the fundamental question of whether raised cholesterol levels really are the cause of heart attacks. [u1] In that article convincing evidence was presented that cholesterol only plays a secondary role in the aetiology of heart disease. In the present article I wish to illustrate and further elaborate on these relationships by means of an actual example in which the patient concerned was put on lifelong statin therapy because of his raised lipid profile without looking further to reveal the real cause.
Typically, the patient will be a 50 – 55-year-old male with unquestionably high lipid levels. The following is an example of such a patient. The patient had clear lipid abnormalities: total cholesterol 7.6 mmol/l (desirable level 5.0 – 5.6), LDL cholesterol 4.9 mol/l (desirable below 3.0), and triglycerides 3.2 mmol/l (desirable 0.5 – 0.7). At 5.5 – 5.7 mmol/l his blood sugar level was at the high end of normal. The patient was slightly overweight and had gained weight over the last 12 months. In addition, the patient complained of mild to moderate fatigue. This constellation of symptoms strongly reminds one of what is called insulin resistance or the metabolic syndrome. One of the typical features of the syndrome is raised blood insulin levels in relation to prevailing blood sugar values. This indicates that the cells are no longer able to utilise blood sugar for the production of energy (hence the fatigue). The accumulation of glucose in the blood leads to increased insulin levels accompanied by increased synthesis of fats (triglycerides) and of cholesterol, which may be deposited in the tissues. The rising insulin levels, however, present a much more serious health hazard. In addition to lipid abnormalities, these are responsible for body weight increases, hypertension, low HDL cholesterol levels, hourly changes in energy level, irritability, sugar cravings and unusual hunger episodes.
Not all of these symptoms have to occur in any particular patient. However, the raised triglycerides and LDL cholesterol values in the presence of low HDL cholesterol values are very typical of the condition. The insulin resistance activates insulin receptors in the liver, which in turn activate cholesterol and triglyceride synthetic pathways in the liver. The raised blood cholesterol levels are of particular significance for the purposes of the present discussion. Many clinicians are unaware of the fact that the raised blood cholesterol values seen in these patients (as well as the other lipid abnormalities discussed above) are symptoms of the metabolic syndrome. Although raised blood cholesterol may have some significance as a cause of coronary heart disease, it is not the principal cause of the condition. The evidence that lowering blood cholesterol values is not an effective strategy to combat heart disease in most people was presented in a previous article (referred to above) and this can now be explained in terms of the metabolic syndrome.
In spite of all this information being freely available, many medical doctors persist in prescribing statins for patients with raised blood cholesterol values. In many cases patients are advised to take these dangerous drugs lifelong. In most cases this tragedy could be prevented if clinicians would be prepared to look beyond drug-induced cholesterol treatment and to look carefully for the signs and symptoms of the metabolic syndrome and to treat this condition.
THE METABOLIC SYNDROME: TREATMENT OPTIONS
The following summarises some of the most important steps that the patient should take.
- Increase dietary protein by increasing the intake of complex proteins such as legumes, nuts, seeds and peas, fish and poultry. Protein helps to even out blood sugar levels and especially to prevent blood sugar surges.
- Include quality fats from fish, nuts and seeds, and use fish-oil capsules as a supplement (4 – 6 g /day). Use olive oil and flax seed oil on salads.
- Supplements (once daily): chromium (400 – 600 mcg as elemental chromium) from chromium polynicotinate or chromium picolinate. Other supplements: cinnamon extract (500 mg), vanadium (50 – 100 mcg), and alpha-lipoic acid (400 mg).
- Take regular small meals instead of 2 or 3 large meals a day. This can be achieved by including suitable snacks between meals.
- Use red yeast rice (1200 mg twice daily) to reduce initial excessively raised cholesterol levels (above 7.5 micromol/l).
Foods to avoid:
- All refined carbohydrates and simple sugars (white bread, cakes, cookies, cool drinks, undiluted fruit juices, etc.).
- Reduce alcoholic drinks to 1 – 2 per day, avoiding those that contain high concentrations of sugar.
- Strictly avoid margarine, and reduce intake of animal fats.
- Avoid artificial sweeteners. Use xylitol as a sweetener (no more than 15 g /day) if necessary.
WHAT CAN YOU EXPECT FROM SUCH A REGIMEN?
Provided that you strictly follow the above advice, you may expect to see the following changes after 2 months:
- Improved sense of wellbeing and more energy
- Much-improved constellation of blood components, as shown in the following example:
T-chol. LDL chol. Triglycerides HDL chol. Blood sugar
mmol/l mmol/l mmol/ l mmol/l mmol/l
Before: 7.2 4.7 3.1 0.9 5.6
months : 5.9 3.1 1.9 1.3 4.9
With these results and provided that the patient continues with the regimen (which he will have to adhere to for the rest of his life), there is no reason to believe that this patient will ever need a statin or any other drug.