DR CABOT: Hello. My name’s Dr Sandra Cabot. And I’m talking today with naturopath and author Margaret Jasinska about understanding your cholesterol levels. Hi, Margaret.

MARGARET: Hi, Dr Cabot. Thanks for having me on. And thank you to you guys for listening.

DR CABOT: And cholesterol is a bit of a controversial subject. Just about every second older person we see is on statin drugs to lower their cholesterol. And people do worry about it because they read about side effects. And sometimes they come to us complaining of side effects. And they often say, “Well, should I stay on these drugs?” And we say, “Well, really, it’s up to you” because some people do need them, if they don’t want to change their diet and lifestyle. So, it’s really a personal choice, isn’t it, Margaret?

MARGARET: Yes, because there is some research, cholesterol-lowering drugs can also help to reduce inflammation. So, they may have more than one mechanism of action. And some people have a lot of risk factors and particularly older men who have already had one heart attack. Taking a statin may help reduce the risk of a future heart attack, if they’re not able to follow the perfect diet.

DR CABOT: Well, it is harder for men. And yes, some people just love carbohydrates and they love deep fried foods and things like that. So, they’re relieved to be able to take a statin.

But let’s look at the normal ranges, if you do have a lipid profile. So, lipid means fat. So, if we’re looking at all the fats in your blood, what do we measure? Well, first of all, we look at your total cholesterol, and the normal range is 2.3 to 5.5 mmol/L. Now, when I started medicine, the normal range was different. It was considered to be up to 6.5. So, it has been brought down over the last 40 years. But that’s still quite a wide range, 2.3 to 5.5. And in my mind, 2.3 is too low. But that’s what the registered laboratory says. So, we have to quote that.

We don’t just look at your total cholesterol. We look at your high density lipoproteins. They’re the healthy or the good cholesterol. And the normal range is 1 to 3 mmol/L. Then we look at the so-called bad cholesterol, which is the LDL, low density lipoprotein, and that range is 0 to 3.5 mmol/L. Then we look at the ratio of your total cholesterol over your HDL. And that ratio is important. That’s from 0 to 4.5. So, we want that to be low because we want your HDL to be high. Then we look at your triglycerides. That’s another fat that’s prevalent in your blood, and it can be a risk factor for cardiovascular diseas,e if it’s too high, because it makes your blood too sticky. So, the normal range for triglyceride fats is 0 to 2.0. So, 0 to 2.0 mmol/L.

So, we look at all those different parameters and we decide, “Well, okay, is it safe for your cardiovascular risk or not?”

MARGARET: Yes. And so, cholesterol is a big topic and a controversial topic. So, we wrote a book about it. It’s called Cholesterol the Real Truth. So, cholesterol does a lot of good things in your body. You wouldn’t survive without it. Your cell membranes are comprised of cholesterol and other fats. You need it for healthy brain function, healthy joints. We make sex hormones out of cholesterol. We make vitamin D out of cholesterol. We make stress hormones out of cholesterol. And so, particularly like for older people who are on a cholesterol-lowering drug, and the drug has made their cholesterol artificially low. So, a level that low, that’s impossible to achieve without a drug. Well, then they’re going to have a sex hormone deficiency. And apart from symptoms like low libido, low levels of sex hormones can also cause aches and pains. It can make you depressed, cause lack of motivation, low mood, just reduce your quality of life in general.

DR CABOT: That’s right. And cholesterol is a very important component of your brain. That’s why some researchers believe that really, really low cholesterol increases your risk of dementia. So, I’m not a believer in really low cholesterol. I know there are schools of thought that say all diabetics should have a cholesterol less than three. I don’t agree with that. I think cholesterol has many important roles and functions in the body. As you said, sex hormones, making vitamin D, important in bile function. It lubricates our tendons and joints. So, me personally, I wouldn’t want really low cholesterol. And I’d say to my patients, “Well, if your cholesterol’s 5.5, to me, that’s fine.” I grew up with higher levels, but other doctors will say, “No, we want it down at 4 or 3.” And really, that’s an individual thing between you and your doctor.

But the interesting thing is your liver has a lot to do with your level of cholesterol. Your liver makes cholesterol. And if you don’t eat any cholesterol-containing foods and become deficient in cholesterol, your liver will make a lot more cholesterol. If you eat too much cholesterol from animal products or dairy products, then your liver will make less. So, it’s a self-regulating process in the body.

MARGARET: Yes. And that process goes wrong if you have an unhealthy liver and also if you are insulin resistant. So, patients often say to me, “Is high cholesterol bad?” And I say in the context of insulin resistance, “Yes!” So, what that means is, if your cholesterol is high but you also have a fatty liver, you also have abdominal obesity, and you have high blood pressure, and you’ve got elevated blood sugar, and your triglycerides are high, then that’s a risk factor. But if your cholesterol is a bit elevated, but all those other things are not, then, well, I think that’s an asset.

DR CABOT: Yes, definitely. Genetic factors are important. Some families, everybody has cholesterol around six or seven, and yet their cholesterol profile is good. In other words, they got a lot of the good cholesterol, the HDL, and not excessive amounts of the LDL. And their triglyceride fats are normal. So that’s genetic, and that’s okay. But as Margaret said, if you’re overweight with syndrome X, insulin resistance, etc, and you’ve got low HCL and high LDL, then in that context, it really is a big risk factor. And you need to get it down either through exercise, not having so much unhealthy fat, like deep fried foods or processed food, not having so much sugar. But if you don’t want to do that, or you could take a statin drug and it will get it down. And it’s very important if you take a statin drug to take a supplement called Co-Enzyme Q10. Otherwise, you’re at more risk of getting side effects, such as muscle pain, muscle tenderness and reduced exercise tolerance.

MARGARET: Yes. And I really try to emphasize to people to make sure what their triglyceride level is. People will often say to me, “Oh, my cholesterol is…”  and they tell me a figure. And I say, “What are your triglycerides?” And they give a blank expression and they don’t know. So, cholesterol is a controversial topic. Triglycerides are not.

DR CABOT: They should be.

MARGARET: All medical professionals agree that triglycerides should be low. We all agree that elevated triglycerides are a heart and stroke and diabetes and metabolic syndrome risk. And triglycerides go up if you have more carbs or sugar or alcohol than your body can tolerate.

DR CABOT: And they’ll make your blood thick and sticky. So, you’re more likely to get blood clots.

So, it’s very important to do a complete lipid profile, looking at your HDL, your LDL, your total cholesterol, your ratio of cholesterol to HDL. And remember, the HDL is the good cholesterol. And to check out your triglycerides. You can also use some natural supplements to help lower cholesterol. Berberine has some good evidence, Margaret.

MARGARET: Absolutely! So berberine is a herbal extract, and you can take it in concentrated form, in capsules. It helps to get elevated cholesterol, triglycerides, blood sugar, insulin. It helps to normalize all of those things, if they are elevated. Helps with weight loss from around the abdomen. So, patients of mine that want to do something about their blood fats, when they go on Berberine, the next blood test result is significantly better.

DR CABOT: Yeah. So, there’s lots you can do. As we said, if it’s familiar and you’ve just got slightly elevated cholesterol, around 6 or 7. But all the other factors there, like your good cholesterol is high and your triglycerides are low, you don’t have to panic. It’s probably not much you can do about it, other than take drugs. But do you really need to take the drugs? That’s where the controversy is.

MARGARET: Yeah. And it depends on what you may be willing to do with your diet and lifestyle. We can tell you that sugar and alcohol are bad for you and they’ll raise your cholesterol. But not everyone’s able to get rid of those or reduce their intake of those things.

DR CABOT: That’s right. So, whether you need a big dose of a statin, well, that’s up to your doctor. But if you do a little bit of improvement in your diet and lifestyle, you may be able to take a much lower dose.

MARGARET: Yes. Exactly! We can find a happy middle ground, perhaps.

DR CABOT: Okay, so now you understand how to read your blood tests for cholesterol and triglycerides, which is very, very important.

And if you have any questions, please email us. We’d love to hear from you.

MARGARET: Thank you, everybody. Bye bye.