Drinking alcohol can raise HDL cholesterol, and this may account for some of the protective effect of very modest amounts of alcohol (1-2 drinks/day for men, 1/day for women) on heart disease risk. But more than that is associated with lots of health problems, including high blood pressure, liver problems, and the list goes on...
On coconut...true, it contains saturated fat, but the specific type - lauric acid - has some beneficial effect on HDL cholesterol too. Until we know more, I'd consume it in moderation.
We're seeing a lot of questions about cholesterol meds. Let's talk about statins and other meds.
Statins are the most-prescribed, and probably best-studied medications in the world. We know that they are associated with a lowered risk of heart disease and stroke. But we also know that some people can have side effects. But the good news is that there are many statins out there with varying strengths and varying likelihood of causing side effects. I might suggest talking to your doctor about considering one of the "weaker" statins that may still provide a benefit without causing as much of a risk of side effects.
People are also asking about at-home cholesterol tests -- are they good or bad? I'd say both. Most cholesterol tests only test your total cholesterol. That really doesn't tell you what you need to know. We need to know the LDL "bad" cholesterol and HDL "good" cholesterol. Some tests do measure those as well but you definitely need to talk to your doctor about your cholesterol levels. Your risk from cholesterol is specific to you. That's why you need to talk to your doctor even if you use one of those tests.
Lovaza is basically a prescription fish oil supplement. And there's definitely been some controversy recently about the benefits of omega-3's as a supplement (as opposed to as part of a diet that includes omega-3's in fish, walnuts, etc.). I believe that the bulk of the evidence points toward some benefit of omega-3 supplements overall, but I do appreciate that some research has suggested otherwise.
Lovaza and Vascepa, another prescription fish oil, are interesting meds. It's one of the very few supplements that has actually become a prescription. These meds are generally reserved for people with very high triglyceride levels. They're fairly new so we're still learning the benefits of lowering triglycerides and the effect on the heart. it's a very important issue, especially for people with diabetes.
One of the interesting things about statin medications is that while they don't seem to have a huge impact on the "amount" of cholesterol plaque (or blockages) in the walls of your blood vessels, they do tend to reduce the risk of more plaque developing, and they also reduce the risk of that plaque breaking off, causing a blood clot to form, and resulting in a heart attack. So even if you have some damage to your blood vessels, it's not too late!
An important point about fish oil prescriptions is that they are at a much higher dose than supplements. So don't rely on a supplement to do what a prescription is intended for. Talk to your doctor to see what you need to do for your high triglycerides and cholesterol.
We've received several questions about coming off of statins. That's a very important point and I'm sure Dr. Beckerman has plenty to say about that!
The thing to keep in mind is that statins are a treatment, not a cure. So when you take away the treatment, you take away its protective effects. So keeping that in mind, if you and your doctor decide that a statin may not be the best choice for you, it's worthwhile to invest in some Therapeutic Lifestyle Changes (TLC for short!) that will help to reduce your risk. Diet, exercise, stress reduction are great things to do for yourself - regardless of whether or not you will also be taking a statin.
Plant sterols and stanols are a great thing to add to your overall healthy diet. You don't ever want to rely on just one type of food to control your cholesterol. But adding these foods to other healthy foods, like fruits, vegetables, and fish, is an excellent way to help get your cholesterol under control.
Niacin has been around for years, and was prescribed as a tool to help increase HDL, lower triglycerides, and less so for LDL. But a very important research study came out recently that showed niacin (when added to a statin) was not associated with any reduction in heart disease risk - so even though it made numbers look better, it didn't actually help people. The same goes for another popular cholesterol-lowering medication, ezemetibe.
I completely agree. We have an amazing opportunity to use our diets, activity, and overall lifestyle to improve our numbers and lower our risk. Sometimes there is a role for medication too. The key is seeing your doctor, knowing your numbers, and making an action plan together.
Thanks everyone! I really appreciate all of your questions. Have a great day!
Thanks so much for being with us Dr. Beckerman and sharing your expertise. Your insight and answers have been invaluable.
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