Many of us have been incited to concern, even fear,  about cholesterol levels.  There has been an enormous media and medical push to reduce cholesterol levels in the past two decades.  Most folks interested in lowering their cholesterol levels have been told this is a risk factor for premature death from cardiovascular disease.  Many doctors, and of course all marketers of cholesterol-lowering drugs, believe having cholesterol above 200 means the patient is more likely to get a heart attack, or die from blocked arteries.

Let’s break this down a bit.  Consider this: Well over 50% of people going to emergency departments with their first heart attack have total cholesterol under 200.  This will be a shock to some readers.  Also, new information is emerging correlating low cholesterol with increased risk of various cancers.

The number 200 is NOT the “end all and be all” of cardiovascular risk, particularly not for women.  In fact, in my opinion, there is way too much emphasis on cholesterol reduction — just because there are drugs out there to “improve” the numbers.

The more northern your ancestry, the more likely you are to have higher cholesterol, because your genes evolved in a climate where food might be scarcer in the winter, so you hang onto fat more aggressively.

More important risk factors for cardiovascular disease are high blood pressure, a big waist, and high C-reactive protein (CRP).  CRP is a readily available blood test that is much more strongly correlated than cholesterol with heart disease risk.  It measures inflammation, and you want your number under 2.5.

Men’s waist size (the tape measure should go around your body just above the belly button) should not exceed 38″ and women’s should not exceed 34″.  This is a quick and easy test I use in my office to evaluate whether or not folks have fat around their abdominal organs: namely the heart, the lungs, the liver and the kidneys.  This deep fat, padding the vital internal organs, will impede optimal blood flow (oxygen delivery) and toxin removal.  Crunches won’t touch this deep fat.  You need to eat less and get more, and regular, cardiovascular exercise.

Blood pressure control is more complicated, but you must explore why the “tubes” (your blood vessels) are constricting, which is why the pressure of the blood flowing through the vascular system increases.  Sometimes caffeine is the vasoconstrictor.  Sometimes it’s stress (adrenaline is an extremely potent vasoconstrictor).

My point is that cholesterol isn’t all bad.  In fact, cholesterol is critical for health.  Cholesterol is the “mother” hormone: estrogens, progesterone, cortisol, aldosterone and testosterone all derive directly from cholesterol.  That’s why total cholesterol goes up in menopausal women: the ovaries are no longer secreting high levels of the female hormones, so the feedback to the brain is “hey, I need more hormones”, so the brain directs the liver to produce more cholesterol — at least until the brain “gets” that the ovaries are on permanent vacation.  It is perfectly fine — NORMAL — for cholesterol to go up to 250 or so around menopause.  Often it will drift down to around 220 or 230 eventually.  No problem.

What IS a problem is obesity and hypertension.  Please don’t be bamboozled into thinking taking a statin is going to reverse your health risks posed by obesity and hypertension.  Statins are not effective for either problem.

Cholesterol is the main ingredient in the cell membrane surrounding each and every one of the trillions of cells in your body.  Cholesterol-rich cell walls allow for appropriate and selective uptake of nutrients which will direct the nucleus of the cell (where the genetic information, or DNA, is stored) to produce energy and proteins and repair enzymes.

Low cholesterol puts people at risk of cancer because the nucleus of the cell may no longer have adequate protection.  Further, cholesterol is a critical component of the nervous system, including the brain and the protective myelin sheath around the nerve.

The only reason to lower cholesterol is if you have proven atherosclerosis (plaque build up inside the arteries, which can inhibit blood and oxygen flow to vital organs including heart and brain).  You are better off lowering cholesterol with niacin or Red Yeast rice than with statin drugs because of the dangerous muscle-wasting side effects of statins.  While niacin can lower total cholesterol levels, generally high doses (2000 – 2500 mg daily, in 3 or 4 divided doses) are needed.  I would go for the inositol hexaniacate “flush-free” variety because otherwise the vasodilation flush is too intense.  However, high dose niacin has been associated with liver damage, so please don’t use this therapy if you already have liver problems.

If you have demonstrable plaque, please consider chelation therapy to pull the plaque off the vessel walls.  If you have heart disease because of arterial plaque (arterio or athero-sclerosis) learn more about clinical trials of chelation therapy here: http://nccam.nih.gov/chelation/chelationstudy.htm